|
MTP FUSION MEDIUM 5 DEG R
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION REVISION LARGE LT
|
Facility
|
IP
|
$7,574.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.65 |
| Max. Negotiated Rate |
$7,271.23 |
| Rate for Payer: Aetna Commercial |
$5,832.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.88
|
| Rate for Payer: Cash Price |
$3,787.10
|
| Rate for Payer: Cigna Commercial |
$6,286.59
|
| Rate for Payer: First Health Commercial |
$7,195.49
|
| Rate for Payer: Humana Commercial |
$6,438.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,665.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,348.00
|
| Rate for Payer: PHCS Commercial |
$7,271.23
|
| Rate for Payer: United Healthcare All Payer |
$6,665.30
|
|
|
MTP FUSION REVISION LARGE LT
|
Facility
|
OP
|
$7,574.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.65 |
| Max. Negotiated Rate |
$7,271.23 |
| Rate for Payer: Aetna Commercial |
$5,832.13
|
| Rate for Payer: Anthem Medicaid |
$2,604.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.88
|
| Rate for Payer: Cash Price |
$3,787.10
|
| Rate for Payer: Cigna Commercial |
$6,286.59
|
| Rate for Payer: First Health Commercial |
$7,195.49
|
| Rate for Payer: Humana Commercial |
$6,438.07
|
| Rate for Payer: Humana KY Medicaid |
$2,604.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,631.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,657.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,665.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,348.00
|
| Rate for Payer: PHCS Commercial |
$7,271.23
|
| Rate for Payer: United Healthcare All Payer |
$6,665.30
|
|
|
MTP FUSION REVISION LARGE RT
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION REVISION LARGE RT
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION REVISION LT
|
Facility
|
IP
|
$7,574.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.65 |
| Max. Negotiated Rate |
$7,271.23 |
| Rate for Payer: Aetna Commercial |
$5,832.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.88
|
| Rate for Payer: Cash Price |
$3,787.10
|
| Rate for Payer: Cigna Commercial |
$6,286.59
|
| Rate for Payer: First Health Commercial |
$7,195.49
|
| Rate for Payer: Humana Commercial |
$6,438.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,665.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,348.00
|
| Rate for Payer: PHCS Commercial |
$7,271.23
|
| Rate for Payer: United Healthcare All Payer |
$6,665.30
|
|
|
MTP FUSION REVISION LT
|
Facility
|
OP
|
$7,574.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.65 |
| Max. Negotiated Rate |
$7,271.23 |
| Rate for Payer: Aetna Commercial |
$5,832.13
|
| Rate for Payer: Anthem Medicaid |
$2,604.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.88
|
| Rate for Payer: Cash Price |
$3,787.10
|
| Rate for Payer: Cigna Commercial |
$6,286.59
|
| Rate for Payer: First Health Commercial |
$7,195.49
|
| Rate for Payer: Humana Commercial |
$6,438.07
|
| Rate for Payer: Humana KY Medicaid |
$2,604.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,631.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,657.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,665.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,348.00
|
| Rate for Payer: PHCS Commercial |
$7,271.23
|
| Rate for Payer: United Healthcare All Payer |
$6,665.30
|
|
|
MTP FUSION REVISION RT
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION REVISION RT
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 0 DEG L
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 0 DEG L
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 0 DEG R
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 0 DEG R
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 10 DEG L
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 10 DEG L
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 10 DEG R
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 10 DEG R
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 5 DEG L
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 5 DEG L
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 5 DEG R
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP FUSION SMALL 5 DEG R
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
MTP PLATE LARGE 5D MPT53-10R
|
Facility
|
OP
|
$7,326.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.38 |
| Max. Negotiated Rate |
$7,032.96 |
| Rate for Payer: Aetna Commercial |
$5,641.02
|
| Rate for Payer: Anthem Medicaid |
$2,519.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,714.28
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$6,080.58
|
| Rate for Payer: First Health Commercial |
$6,959.70
|
| Rate for Payer: Humana Commercial |
$6,227.10
|
| Rate for Payer: Humana KY Medicaid |
$2,519.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,007.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,406.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,569.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,446.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,494.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$952.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.06
|
| Rate for Payer: PHCS Commercial |
$7,032.96
|
| Rate for Payer: United Healthcare All Payer |
$6,446.88
|
|
|
MTP PLATE LARGE 5D MPT53-10R
|
Facility
|
IP
|
$7,326.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.38 |
| Max. Negotiated Rate |
$7,032.96 |
| Rate for Payer: Aetna Commercial |
$5,641.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,714.28
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$6,080.58
|
| Rate for Payer: First Health Commercial |
$6,959.70
|
| Rate for Payer: Humana Commercial |
$6,227.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,007.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,406.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,446.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,494.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$952.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.06
|
| Rate for Payer: PHCS Commercial |
$7,032.96
|
| Rate for Payer: United Healthcare All Payer |
$6,446.88
|
|
|
MTP PLATE MEDIUM 0D 45 MM RIGH
|
Facility
|
OP
|
$7,326.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.38 |
| Max. Negotiated Rate |
$7,032.96 |
| Rate for Payer: Aetna Commercial |
$5,641.02
|
| Rate for Payer: Anthem Medicaid |
$2,519.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,714.28
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$6,080.58
|
| Rate for Payer: First Health Commercial |
$6,959.70
|
| Rate for Payer: Humana Commercial |
$6,227.10
|
| Rate for Payer: Humana KY Medicaid |
$2,519.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,007.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,406.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,569.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,446.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,494.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$952.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.06
|
| Rate for Payer: PHCS Commercial |
$7,032.96
|
| Rate for Payer: United Healthcare All Payer |
$6,446.88
|
|
|
MTP PLATE MEDIUM 0D 45 MM RIGH
|
Facility
|
IP
|
$7,326.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$952.38 |
| Max. Negotiated Rate |
$7,032.96 |
| Rate for Payer: Aetna Commercial |
$5,641.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,714.28
|
| Rate for Payer: Cash Price |
$3,663.00
|
| Rate for Payer: Cigna Commercial |
$6,080.58
|
| Rate for Payer: First Health Commercial |
$6,959.70
|
| Rate for Payer: Humana Commercial |
$6,227.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,007.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,406.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,446.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,494.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$952.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.06
|
| Rate for Payer: PHCS Commercial |
$7,032.96
|
| Rate for Payer: United Healthcare All Payer |
$6,446.88
|
|
