|
LIFESTREAM COV. STENT 7*58*135
|
Facility
|
OP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem Medicaid |
$6,284.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Humana KY Medicaid |
$6,284.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,410.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
LIFESTREAM COV. STENT 7*58*135
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
LIFESTREAM COV. STENT 8*16*135
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
LIFESTREAM COV. STENT 8*16*135
|
Facility
|
OP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem Medicaid |
$6,284.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Humana KY Medicaid |
$6,284.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,410.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
LIFESTREAM COV. STENT 8*26*135
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
LIFESTREAM COV. STENT 8*26*135
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
LIFESTREAM COV. STENT 8*37*135
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LIFESTREAM COV. STENT 8*37*135
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LIFESTREAM COV. STENT 8*58*135
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
LIFESTREAM COV. STENT 8*58*135
|
Facility
|
OP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem Medicaid |
$6,284.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Humana KY Medicaid |
$6,284.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,410.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
LIFESTREAM COV. STENT 9*38*135
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
LIFESTREAM COV. STENT 9*38*135
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
LIFESTREAM COV. STENT 9*58*135
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
LIFESTREAM COV. STENT 9*58*135
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
LIGAMENT PATELLAR PRE-SHP 10MM
|
Facility
|
OP
|
$15,564.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,669.43 |
| Max. Negotiated Rate |
$14,942.16 |
| Rate for Payer: Aetna Commercial |
$11,984.86
|
| Rate for Payer: Anthem Medicaid |
$5,352.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,140.50
|
| Rate for Payer: Cash Price |
$7,782.38
|
| Rate for Payer: Cigna Commercial |
$12,918.74
|
| Rate for Payer: First Health Commercial |
$14,786.51
|
| Rate for Payer: Humana Commercial |
$13,230.04
|
| Rate for Payer: Humana KY Medicaid |
$5,352.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,407.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,486.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,669.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,460.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,696.98
|
| Rate for Payer: Ohio Health Group HMO |
$11,673.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,451.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,541.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,739.68
|
| Rate for Payer: PHCS Commercial |
$14,942.16
|
| Rate for Payer: United Healthcare All Payer |
$13,696.98
|
|
|
LIGAMENT PATELLAR PRE-SHP 10MM
|
Facility
|
IP
|
$15,564.75
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,669.43 |
| Max. Negotiated Rate |
$14,942.16 |
| Rate for Payer: Aetna Commercial |
$11,984.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,140.50
|
| Rate for Payer: Cash Price |
$7,782.38
|
| Rate for Payer: Cigna Commercial |
$12,918.74
|
| Rate for Payer: First Health Commercial |
$14,786.51
|
| Rate for Payer: Humana Commercial |
$13,230.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,763.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,486.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,669.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,696.98
|
| Rate for Payer: Ohio Health Group HMO |
$11,673.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,451.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,541.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,739.68
|
| Rate for Payer: PHCS Commercial |
$14,942.16
|
| Rate for Payer: United Healthcare All Payer |
$13,696.98
|
|
|
LIGAMENT RECON KNEE INTARTIC
|
Facility
|
IP
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
76100843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.50 |
| Max. Negotiated Rate |
$3,393.60 |
| Rate for Payer: Aetna Commercial |
$2,721.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.30
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$2,934.05
|
| Rate for Payer: First Health Commercial |
$3,358.25
|
| Rate for Payer: Humana Commercial |
$3,004.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,075.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.15
|
| Rate for Payer: PHCS Commercial |
$3,393.60
|
| Rate for Payer: United Healthcare All Payer |
$3,110.80
|
|
|
LIGAMENT RECON KNEE INTARTIC
|
Facility
|
OP
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
76100843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,215.69 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,721.95
|
| Rate for Payer: Anthem Medicaid |
$1,215.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$2,934.05
|
| Rate for Payer: First Health Commercial |
$3,358.25
|
| Rate for Payer: Humana Commercial |
$3,004.75
|
| Rate for Payer: Humana KY Medicaid |
$1,215.69
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,228.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,240.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,075.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.15
|
| Rate for Payer: PHCS Commercial |
$3,393.60
|
| Rate for Payer: United Healthcare All Payer |
$3,110.80
|
|
|
LIGAMENT RECON KNEE INTARTIC
|
Professional
|
Both
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
76100843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$745.89 |
| Max. Negotiated Rate |
$2,121.00 |
| Rate for Payer: Aetna Commercial |
$1,625.81
|
| Rate for Payer: Ambetter Exchange |
$1,063.39
|
| Rate for Payer: Anthem Medicaid |
$745.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,063.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,063.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,276.07
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$1,759.85
|
| Rate for Payer: Healthspan PPO |
$1,472.63
|
| Rate for Payer: Humana Medicaid |
$745.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,382.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,063.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,063.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$760.81
|
| Rate for Payer: Molina Healthcare Passport |
$745.89
|
| Rate for Payer: Multiplan PHCS |
$2,121.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,382.41
|
| Rate for Payer: UHCCP Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$753.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,063.39
|
|
|
LIGAMENT RECON KNEE INTARTIC(P
|
Professional
|
Both
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27428
|
| Hospital Charge Code |
761P0843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$745.89 |
| Max. Negotiated Rate |
$2,121.00 |
| Rate for Payer: Aetna Commercial |
$1,625.81
|
| Rate for Payer: Ambetter Exchange |
$1,063.39
|
| Rate for Payer: Anthem Medicaid |
$745.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,063.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,063.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,276.07
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$1,759.85
|
| Rate for Payer: Healthspan PPO |
$1,472.63
|
| Rate for Payer: Humana Medicaid |
$745.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,382.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,063.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,063.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$760.81
|
| Rate for Payer: Molina Healthcare Passport |
$745.89
|
| Rate for Payer: Multiplan PHCS |
$2,121.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,382.41
|
| Rate for Payer: UHCCP Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$753.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,063.39
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
761P0842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.63 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$1,055.85
|
| Rate for Payer: Ambetter Exchange |
$675.35
|
| Rate for Payer: Anthem Medicaid |
$607.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$810.42
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$1,154.45
|
| Rate for Payer: Healthspan PPO |
$956.38
|
| Rate for Payer: Humana Medicaid |
$607.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$888.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.78
|
| Rate for Payer: Molina Healthcare Passport |
$607.63
|
| Rate for Payer: Multiplan PHCS |
$1,740.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.96
|
| Rate for Payer: UHCCP Medicaid |
$1,015.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$613.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.35
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Facility
|
IP
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
76100842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$870.00 |
| Max. Negotiated Rate |
$2,784.00 |
| Rate for Payer: Aetna Commercial |
$2,233.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,262.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$2,407.00
|
| Rate for Payer: First Health Commercial |
$2,755.00
|
| Rate for Payer: Humana Commercial |
$2,465.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,378.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,140.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$870.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,552.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,523.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,001.00
|
| Rate for Payer: PHCS Commercial |
$2,784.00
|
| Rate for Payer: United Healthcare All Payer |
$2,552.00
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
76100842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$997.31 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$2,233.00
|
| Rate for Payer: Anthem Medicaid |
$997.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,262.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$2,407.00
|
| Rate for Payer: First Health Commercial |
$2,755.00
|
| Rate for Payer: Humana Commercial |
$2,465.00
|
| Rate for Payer: Humana KY Medicaid |
$997.31
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,007.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,378.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,140.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,017.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,552.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,523.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,001.00
|
| Rate for Payer: PHCS Commercial |
$2,784.00
|
| Rate for Payer: United Healthcare All Payer |
$2,552.00
|
|
|
LIGAMENT RECON KNEE XARTICULAR
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
HCPCS 27427
|
| Hospital Charge Code |
76100842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.63 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$1,055.85
|
| Rate for Payer: Ambetter Exchange |
$675.35
|
| Rate for Payer: Anthem Medicaid |
$607.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$810.42
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cash Price |
$1,450.00
|
| Rate for Payer: Cigna Commercial |
$1,154.45
|
| Rate for Payer: Healthspan PPO |
$956.38
|
| Rate for Payer: Humana Medicaid |
$607.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$888.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.78
|
| Rate for Payer: Molina Healthcare Passport |
$607.63
|
| Rate for Payer: Multiplan PHCS |
$1,740.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.96
|
| Rate for Payer: UHCCP Medicaid |
$1,015.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$613.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.35
|
|
