|
INSERT FLX XLPE HI PS 1-2 10MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 1-2 10MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 1-2 12MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 1-2 12MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 3-4 10MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 3-4 10MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 3-4 12MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 3-4 12MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 5-6 10MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 5-6 10MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 5-6 12MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 5-6 12MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 7-8 10MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 7-8 10MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 7-8 12MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FLX XLPE HI PS 7-8 12MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
INSERT FX BEAR STB SZ 2 22.5MM
|
Facility
|
OP
|
$12,267.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,680.29 |
| Max. Negotiated Rate |
$11,776.92 |
| Rate for Payer: Aetna Commercial |
$9,446.08
|
| Rate for Payer: Anthem Medicaid |
$4,218.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,568.75
|
| Rate for Payer: Cash Price |
$6,133.81
|
| Rate for Payer: Cigna Commercial |
$10,182.13
|
| Rate for Payer: First Health Commercial |
$11,654.25
|
| Rate for Payer: Humana Commercial |
$10,427.49
|
| Rate for Payer: Humana KY Medicaid |
$4,218.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,261.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,059.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,053.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,680.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,303.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,795.51
|
| Rate for Payer: Ohio Health Group HMO |
$9,200.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,814.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,672.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,464.66
|
| Rate for Payer: PHCS Commercial |
$11,776.92
|
| Rate for Payer: United Healthcare All Payer |
$10,795.51
|
|
|
INSERT FX BEAR STB SZ 2 22.5MM
|
Facility
|
IP
|
$12,267.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,680.29 |
| Max. Negotiated Rate |
$11,776.92 |
| Rate for Payer: Aetna Commercial |
$9,446.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,568.75
|
| Rate for Payer: Cash Price |
$6,133.81
|
| Rate for Payer: Cigna Commercial |
$10,182.13
|
| Rate for Payer: First Health Commercial |
$11,654.25
|
| Rate for Payer: Humana Commercial |
$10,427.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,059.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,053.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,680.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,795.51
|
| Rate for Payer: Ohio Health Group HMO |
$9,200.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,814.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,672.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,464.66
|
| Rate for Payer: PHCS Commercial |
$11,776.92
|
| Rate for Payer: United Healthcare All Payer |
$10,795.51
|
|
|
INSERT FX BEAR STB SZ 2.5 15MM
|
Facility
|
IP
|
$16,206.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,862.01 |
| Max. Negotiated Rate |
$15,558.43 |
| Rate for Payer: Aetna Commercial |
$12,479.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,641.23
|
| Rate for Payer: Cash Price |
$8,103.35
|
| Rate for Payer: Cigna Commercial |
$13,451.56
|
| Rate for Payer: First Health Commercial |
$15,396.36
|
| Rate for Payer: Humana Commercial |
$13,775.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,289.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,960.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,261.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,155.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,965.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,099.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,182.62
|
| Rate for Payer: PHCS Commercial |
$15,558.43
|
| Rate for Payer: United Healthcare All Payer |
$14,261.90
|
|
|
INSERT FX BEAR STB SZ 2.5 15MM
|
Facility
|
OP
|
$16,206.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,862.01 |
| Max. Negotiated Rate |
$15,558.43 |
| Rate for Payer: Aetna Commercial |
$12,479.16
|
| Rate for Payer: Anthem Medicaid |
$5,573.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,641.23
|
| Rate for Payer: Cash Price |
$8,103.35
|
| Rate for Payer: Cigna Commercial |
$13,451.56
|
| Rate for Payer: First Health Commercial |
$15,396.36
|
| Rate for Payer: Humana Commercial |
$13,775.69
|
| Rate for Payer: Humana KY Medicaid |
$5,573.48
|
| Rate for Payer: Kentucky WC Medicaid |
$5,630.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,289.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,960.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,862.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,685.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,261.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,155.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,965.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,099.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,182.62
|
| Rate for Payer: PHCS Commercial |
$15,558.43
|
| Rate for Payer: United Healthcare All Payer |
$14,261.90
|
|
|
INSERT FX BEAR STB SZ 3 12.5MM
|
Facility
|
OP
|
$15,862.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,758.78 |
| Max. Negotiated Rate |
$15,228.10 |
| Rate for Payer: Aetna Commercial |
$12,214.20
|
| Rate for Payer: Anthem Medicaid |
$5,455.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,372.83
|
| Rate for Payer: Cash Price |
$7,931.30
|
| Rate for Payer: Cigna Commercial |
$13,165.96
|
| Rate for Payer: First Health Commercial |
$15,069.47
|
| Rate for Payer: Humana Commercial |
$13,483.21
|
| Rate for Payer: Humana KY Medicaid |
$5,455.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,510.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,007.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,706.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,758.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,564.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,959.09
|
| Rate for Payer: Ohio Health Group HMO |
$11,896.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,690.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,800.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,945.19
|
| Rate for Payer: PHCS Commercial |
$15,228.10
|
| Rate for Payer: United Healthcare All Payer |
$13,959.09
|
|
|
INSERT FX BEAR STB SZ 3 12.5MM
|
Facility
|
IP
|
$15,862.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,758.78 |
| Max. Negotiated Rate |
$15,228.10 |
| Rate for Payer: Aetna Commercial |
$12,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,372.83
|
| Rate for Payer: Cash Price |
$7,931.30
|
| Rate for Payer: Cigna Commercial |
$13,165.96
|
| Rate for Payer: First Health Commercial |
$15,069.47
|
| Rate for Payer: Humana Commercial |
$13,483.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,007.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,706.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,758.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,959.09
|
| Rate for Payer: Ohio Health Group HMO |
$11,896.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,690.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,800.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,945.19
|
| Rate for Payer: PHCS Commercial |
$15,228.10
|
| Rate for Payer: United Healthcare All Payer |
$13,959.09
|
|
|
INSERT FX BEAR STB SZ 3 8MM
|
Facility
|
OP
|
$10,128.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,038.53 |
| Max. Negotiated Rate |
$9,723.31 |
| Rate for Payer: Aetna Commercial |
$7,798.91
|
| Rate for Payer: Anthem Medicaid |
$3,483.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,900.19
|
| Rate for Payer: Cash Price |
$5,064.23
|
| Rate for Payer: Cigna Commercial |
$8,406.61
|
| Rate for Payer: First Health Commercial |
$9,622.03
|
| Rate for Payer: Humana Commercial |
$8,609.18
|
| Rate for Payer: Humana KY Medicaid |
$3,483.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,518.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,305.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,474.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,038.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,553.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,913.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,596.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,102.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,811.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,988.63
|
| Rate for Payer: PHCS Commercial |
$9,723.31
|
| Rate for Payer: United Healthcare All Payer |
$8,913.04
|
|
|
INSERT FX BEAR STB SZ 3 8MM
|
Facility
|
IP
|
$10,128.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,038.53 |
| Max. Negotiated Rate |
$9,723.31 |
| Rate for Payer: Aetna Commercial |
$7,798.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,900.19
|
| Rate for Payer: Cash Price |
$5,064.23
|
| Rate for Payer: Cigna Commercial |
$8,406.61
|
| Rate for Payer: First Health Commercial |
$9,622.03
|
| Rate for Payer: Humana Commercial |
$8,609.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,305.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,474.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,038.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,913.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,596.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,102.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,811.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,988.63
|
| Rate for Payer: PHCS Commercial |
$9,723.31
|
| Rate for Payer: United Healthcare All Payer |
$8,913.04
|
|
|
INSERT FX BEAR STB SZ 4 10MM
|
Facility
|
IP
|
$15,862.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,758.78 |
| Max. Negotiated Rate |
$15,228.10 |
| Rate for Payer: Aetna Commercial |
$12,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,372.83
|
| Rate for Payer: Cash Price |
$7,931.30
|
| Rate for Payer: Cigna Commercial |
$13,165.96
|
| Rate for Payer: First Health Commercial |
$15,069.47
|
| Rate for Payer: Humana Commercial |
$13,483.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,007.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,706.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,758.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,959.09
|
| Rate for Payer: Ohio Health Group HMO |
$11,896.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,690.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,800.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,945.19
|
| Rate for Payer: PHCS Commercial |
$15,228.10
|
| Rate for Payer: United Healthcare All Payer |
$13,959.09
|
|
