|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$17,237.30
|
|
|
Service Code
|
MSDRG 054
|
| Min. Negotiated Rate |
$11,696.74 |
| Max. Negotiated Rate |
$17,237.30 |
| Rate for Payer: Anthem Medicaid |
$11,696.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,312.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,237.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,621.69
|
| Rate for Payer: Humana KY Medicaid |
$11,696.74
|
| Rate for Payer: Humana Medicare Advantage |
$12,312.36
|
| Rate for Payer: Kentucky WC Medicaid |
$11,813.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,774.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,930.68
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$12,554.51
|
|
|
Service Code
|
MSDRG 055
|
| Min. Negotiated Rate |
$8,519.13 |
| Max. Negotiated Rate |
$12,554.51 |
| Rate for Payer: Anthem Medicaid |
$8,519.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,967.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,554.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,106.14
|
| Rate for Payer: Humana KY Medicaid |
$8,519.13
|
| Rate for Payer: Humana Medicare Advantage |
$8,967.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,604.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,761.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,689.52
|
|
|
NESTER COIL 14*6
|
Facility
|
IP
|
$1,719.88
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$223.58 |
| Max. Negotiated Rate |
$1,651.08 |
| Rate for Payer: Aetna Commercial |
$1,324.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.51
|
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Cigna Commercial |
$1,427.50
|
| Rate for Payer: First Health Commercial |
$1,633.89
|
| Rate for Payer: Humana Commercial |
$1,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,289.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.16
|
| Rate for Payer: PHCS Commercial |
$1,651.08
|
| Rate for Payer: United Healthcare All Payer |
$1,513.49
|
|
|
NESTER COIL 14*6
|
Facility
|
OP
|
$1,719.88
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$223.58 |
| Max. Negotiated Rate |
$1,651.08 |
| Rate for Payer: Aetna Commercial |
$1,324.31
|
| Rate for Payer: Anthem Medicaid |
$591.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.51
|
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Cigna Commercial |
$1,427.50
|
| Rate for Payer: First Health Commercial |
$1,633.89
|
| Rate for Payer: Humana Commercial |
$1,461.90
|
| Rate for Payer: Humana KY Medicaid |
$591.47
|
| Rate for Payer: Kentucky WC Medicaid |
$597.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,289.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.16
|
| Rate for Payer: PHCS Commercial |
$1,651.08
|
| Rate for Payer: United Healthcare All Payer |
$1,513.49
|
|
|
NESTER COIL 4MM
|
Facility
|
OP
|
$1,740.21
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$226.23 |
| Max. Negotiated Rate |
$1,670.60 |
| Rate for Payer: Aetna Commercial |
$1,339.96
|
| Rate for Payer: Anthem Medicaid |
$598.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.36
|
| Rate for Payer: Cash Price |
$870.11
|
| Rate for Payer: Cigna Commercial |
$1,444.37
|
| Rate for Payer: First Health Commercial |
$1,653.20
|
| Rate for Payer: Humana Commercial |
$1,479.18
|
| Rate for Payer: Humana KY Medicaid |
$598.46
|
| Rate for Payer: Kentucky WC Medicaid |
$604.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.47
|
| Rate for Payer: PHCS Commercial |
$1,670.60
|
| Rate for Payer: United Healthcare All Payer |
$1,531.38
|
|
|
NESTER COIL 4MM
|
Facility
|
IP
|
$1,740.21
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$226.23 |
| Max. Negotiated Rate |
$1,670.60 |
| Rate for Payer: Aetna Commercial |
$1,339.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.36
|
| Rate for Payer: Cash Price |
$870.11
|
| Rate for Payer: Cigna Commercial |
$1,444.37
|
| Rate for Payer: First Health Commercial |
$1,653.20
|
| Rate for Payer: Humana Commercial |
$1,479.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.47
|
| Rate for Payer: PHCS Commercial |
$1,670.60
|
| Rate for Payer: United Healthcare All Payer |
$1,531.38
|
|
|
NESTER COIL 6MM
|
Facility
|
IP
|
$1,740.21
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$226.23 |
| Max. Negotiated Rate |
$1,670.60 |
| Rate for Payer: Aetna Commercial |
$1,339.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.36
|
| Rate for Payer: Cash Price |
$870.11
|
| Rate for Payer: Cigna Commercial |
$1,444.37
|
| Rate for Payer: First Health Commercial |
$1,653.20
|
| Rate for Payer: Humana Commercial |
$1,479.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.47
|
| Rate for Payer: PHCS Commercial |
$1,670.60
|
| Rate for Payer: United Healthcare All Payer |
$1,531.38
|
|
|
NESTER COIL 6MM
|
Facility
|
OP
|
$1,740.21
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$226.23 |
| Max. Negotiated Rate |
$1,670.60 |
| Rate for Payer: Aetna Commercial |
$1,339.96
|
| Rate for Payer: Anthem Medicaid |
$598.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.36
|
| Rate for Payer: Cash Price |
$870.11
|
| Rate for Payer: Cigna Commercial |
$1,444.37
|
| Rate for Payer: First Health Commercial |
$1,653.20
|
| Rate for Payer: Humana Commercial |
$1,479.18
|
| Rate for Payer: Humana KY Medicaid |
$598.46
|
| Rate for Payer: Kentucky WC Medicaid |
$604.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.47
|
| Rate for Payer: PHCS Commercial |
$1,670.60
|
| Rate for Payer: United Healthcare All Payer |
$1,531.38
|
|
|
NESTER COIL 8MM
|
Facility
|
OP
|
$1,719.88
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$223.58 |
| Max. Negotiated Rate |
$1,651.08 |
| Rate for Payer: Aetna Commercial |
$1,324.31
|
| Rate for Payer: Anthem Medicaid |
$591.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.51
|
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Cigna Commercial |
$1,427.50
|
| Rate for Payer: First Health Commercial |
$1,633.89
|
| Rate for Payer: Humana Commercial |
$1,461.90
|
| Rate for Payer: Humana KY Medicaid |
$591.47
|
| Rate for Payer: Kentucky WC Medicaid |
$597.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,289.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.16
|
| Rate for Payer: PHCS Commercial |
$1,651.08
|
| Rate for Payer: United Healthcare All Payer |
$1,513.49
|
|
|
NESTER COIL 8MM
|
Facility
|
IP
|
$1,719.88
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$223.58 |
| Max. Negotiated Rate |
$1,651.08 |
| Rate for Payer: Aetna Commercial |
$1,324.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.51
|
| Rate for Payer: Cash Price |
$859.94
|
| Rate for Payer: Cigna Commercial |
$1,427.50
|
| Rate for Payer: First Health Commercial |
$1,633.89
|
| Rate for Payer: Humana Commercial |
$1,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,289.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.16
|
| Rate for Payer: PHCS Commercial |
$1,651.08
|
| Rate for Payer: United Healthcare All Payer |
$1,513.49
|
|
|
NEUFLEX MCP IMPLANT SZ 0
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 0
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 10
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 10
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 20
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 20
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 30
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 30
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 40
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 40
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 50
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 50
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 60
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX MCP IMPLANT SZ 60
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
NEUFLEX PIP IMPLANT SZ 1
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
