|
INTERLOCK 20*50
|
Facility
|
IP
|
$5,544.25
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.75 |
| Max. Negotiated Rate |
$5,322.48 |
| Rate for Payer: Aetna Commercial |
$4,269.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,324.52
|
| Rate for Payer: Cash Price |
$2,772.12
|
| Rate for Payer: Cigna Commercial |
$4,601.73
|
| Rate for Payer: First Health Commercial |
$5,267.04
|
| Rate for Payer: Humana Commercial |
$4,712.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,546.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,091.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,878.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,158.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,108.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,718.72
|
| Rate for Payer: PHCS Commercial |
$5,322.48
|
| Rate for Payer: United Healthcare All Payer |
$4,878.94
|
|
|
INTERLOCK 20*50
|
Facility
|
OP
|
$5,544.25
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.75 |
| Max. Negotiated Rate |
$5,322.48 |
| Rate for Payer: Aetna Commercial |
$4,269.07
|
| Rate for Payer: Anthem Medicaid |
$1,906.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,324.52
|
| Rate for Payer: Cash Price |
$2,772.12
|
| Rate for Payer: Cigna Commercial |
$4,601.73
|
| Rate for Payer: First Health Commercial |
$5,267.04
|
| Rate for Payer: Humana Commercial |
$4,712.61
|
| Rate for Payer: Humana KY Medicaid |
$1,906.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,926.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,546.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,091.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,944.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,878.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,158.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,108.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,718.72
|
| Rate for Payer: PHCS Commercial |
$5,322.48
|
| Rate for Payer: United Healthcare All Payer |
$4,878.94
|
|
|
INTERNALBRACE AR-1789J-CP
|
Facility
|
IP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
INTERNALBRACE AR-1789J-CP
|
Facility
|
OP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem Medicaid |
$2,839.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Humana KY Medicaid |
$2,839.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
INTERNALBRACE LGMT AUG RPR KIT
|
Facility
|
IP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
INTERNALBRACE LGMT AUG RPR KIT
|
Facility
|
OP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem Medicaid |
$2,839.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Humana KY Medicaid |
$2,839.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
INTERNAL NERVE REVISION
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 64727
|
| Hospital Charge Code |
76102366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
INTERNAL NERVE REVISION
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 64727
|
| Hospital Charge Code |
76102366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
INTERNAL NERVE REVISION
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 64727
|
| Hospital Charge Code |
76102366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$307.67
|
| Rate for Payer: Anthem Medicaid |
$191.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$283.13
|
| Rate for Payer: Healthspan PPO |
$240.22
|
| Rate for Payer: Humana Medicaid |
$191.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.05
|
| Rate for Payer: Molina Healthcare Passport |
$191.23
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.14
|
|
|
INTERNAL NERVE REVISION(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 64727
|
| Hospital Charge Code |
761P2366
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$307.67
|
| Rate for Payer: Anthem Medicaid |
$191.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$283.13
|
| Rate for Payer: Healthspan PPO |
$240.22
|
| Rate for Payer: Humana Medicaid |
$191.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$240.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.05
|
| Rate for Payer: Molina Healthcare Passport |
$191.23
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.14
|
|
|
INTERROG DEV EVAL ICPMS IP
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93290
|
| Hospital Charge Code |
48000085
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$53.04
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$53.05
|
| Rate for Payer: Healthspan PPO |
$49.85
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
INTERROG DEV EVAL ICPMS IP
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 93290
|
| Hospital Charge Code |
48000085
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$32.61
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
INTERROG DEV EVAL ICPMS IP
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 93290
|
| Hospital Charge Code |
48000085
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
INTERROG DEV EVAL SCRMS IP
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 93291
|
| Hospital Charge Code |
48000086
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
INTERROG DEV EVAL SCRMS IP
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 93291
|
| Hospital Charge Code |
48000086
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
INTERSPACE HIP SPC0022
|
Facility
|
OP
|
$17,952.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,333.76 |
| Max. Negotiated Rate |
$17,233.92 |
| Rate for Payer: Aetna Commercial |
$13,823.04
|
| Rate for Payer: Anthem Medicaid |
$6,173.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,002.56
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cigna Commercial |
$14,900.16
|
| Rate for Payer: First Health Commercial |
$17,054.40
|
| Rate for Payer: Humana Commercial |
$15,259.20
|
| Rate for Payer: Humana KY Medicaid |
$6,173.69
|
| Rate for Payer: Kentucky WC Medicaid |
$6,236.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,720.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,248.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,385.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,797.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,565.12
|
| Rate for Payer: PHCS Commercial |
$17,233.92
|
| Rate for Payer: United Healthcare All Payer |
$15,797.76
|
|
|
INTERSPACE HIP SPC0022
|
Facility
|
IP
|
$17,952.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,333.76 |
| Max. Negotiated Rate |
$17,233.92 |
| Rate for Payer: Aetna Commercial |
$13,823.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,002.56
|
| Rate for Payer: Cash Price |
$8,976.00
|
| Rate for Payer: Cigna Commercial |
$14,900.16
|
| Rate for Payer: First Health Commercial |
$17,054.40
|
| Rate for Payer: Humana Commercial |
$15,259.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,720.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,248.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,385.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,797.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,464.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,333.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,565.12
|
| Rate for Payer: PHCS Commercial |
$17,233.92
|
| Rate for Payer: United Healthcare All Payer |
$15,797.76
|
|
|
INTERSPACE KNEE LRG
|
Facility
|
OP
|
$15,216.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,978.08 |
| Max. Negotiated Rate |
$14,607.36 |
| Rate for Payer: Aetna Commercial |
$11,716.32
|
| Rate for Payer: Anthem Medicaid |
$5,232.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,868.48
|
| Rate for Payer: Cash Price |
$7,608.00
|
| Rate for Payer: Cigna Commercial |
$12,629.28
|
| Rate for Payer: First Health Commercial |
$14,455.20
|
| Rate for Payer: Humana Commercial |
$12,933.60
|
| Rate for Payer: Humana KY Medicaid |
$5,232.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,286.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,477.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,229.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,564.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,337.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,390.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,412.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,978.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,716.96
|
| Rate for Payer: PHCS Commercial |
$14,607.36
|
| Rate for Payer: United Healthcare All Payer |
$13,390.08
|
|
|
INTERSPACE KNEE LRG
|
Facility
|
IP
|
$15,216.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,978.08 |
| Max. Negotiated Rate |
$14,607.36 |
| Rate for Payer: Aetna Commercial |
$11,716.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,868.48
|
| Rate for Payer: Cash Price |
$7,608.00
|
| Rate for Payer: Cigna Commercial |
$12,629.28
|
| Rate for Payer: First Health Commercial |
$14,455.20
|
| Rate for Payer: Humana Commercial |
$12,933.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,477.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,229.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,564.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,390.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,412.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,978.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,716.96
|
| Rate for Payer: PHCS Commercial |
$14,607.36
|
| Rate for Payer: United Healthcare All Payer |
$13,390.08
|
|
|
INTERSPACE KNEE MED
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
INTERSPACE KNEE MED
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
INTERSPACE KNEE SM
|
Facility
|
IP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
INTERSPACE KNEE SM
|
Facility
|
OP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem Medicaid |
$5,901.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Humana KY Medicaid |
$5,901.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
INTERSPACE KNEE XLRG
|
Facility
|
IP
|
$15,216.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,978.08 |
| Max. Negotiated Rate |
$14,607.36 |
| Rate for Payer: Aetna Commercial |
$11,716.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,868.48
|
| Rate for Payer: Cash Price |
$7,608.00
|
| Rate for Payer: Cigna Commercial |
$12,629.28
|
| Rate for Payer: First Health Commercial |
$14,455.20
|
| Rate for Payer: Humana Commercial |
$12,933.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,477.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,229.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,564.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,390.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,412.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,978.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,716.96
|
| Rate for Payer: PHCS Commercial |
$14,607.36
|
| Rate for Payer: United Healthcare All Payer |
$13,390.08
|
|
|
INTERSPACE KNEE XLRG
|
Facility
|
OP
|
$15,216.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,978.08 |
| Max. Negotiated Rate |
$14,607.36 |
| Rate for Payer: Aetna Commercial |
$11,716.32
|
| Rate for Payer: Anthem Medicaid |
$5,232.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,868.48
|
| Rate for Payer: Cash Price |
$7,608.00
|
| Rate for Payer: Cigna Commercial |
$12,629.28
|
| Rate for Payer: First Health Commercial |
$14,455.20
|
| Rate for Payer: Humana Commercial |
$12,933.60
|
| Rate for Payer: Humana KY Medicaid |
$5,232.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,286.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,477.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,229.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,564.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,337.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,390.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,412.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,978.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,716.96
|
| Rate for Payer: PHCS Commercial |
$14,607.36
|
| Rate for Payer: United Healthcare All Payer |
$13,390.08
|
|
