|
OPTEASE CAVA FILTER 90CM
|
Facility
|
OP
|
$9,351.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.73 |
| Max. Negotiated Rate |
$8,977.68 |
| Rate for Payer: Aetna Commercial |
$7,200.85
|
| Rate for Payer: Anthem Medicaid |
$3,216.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.36
|
| Rate for Payer: Cash Price |
$4,675.88
|
| Rate for Payer: Cigna Commercial |
$7,761.95
|
| Rate for Payer: First Health Commercial |
$8,884.16
|
| Rate for Payer: Humana Commercial |
$7,948.99
|
| Rate for Payer: Humana KY Medicaid |
$3,216.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,668.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,229.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,870.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,899.04
|
| Rate for Payer: PHCS Commercial |
$8,977.68
|
| Rate for Payer: United Healthcare All Payer |
$8,229.54
|
|
|
OPTEASE CAVA FILTER 90CM
|
Facility
|
IP
|
$9,351.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.73 |
| Max. Negotiated Rate |
$8,977.68 |
| Rate for Payer: Aetna Commercial |
$7,200.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.36
|
| Rate for Payer: Cash Price |
$4,675.88
|
| Rate for Payer: Cigna Commercial |
$7,761.95
|
| Rate for Payer: First Health Commercial |
$8,884.16
|
| Rate for Payer: Humana Commercial |
$7,948.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,668.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,229.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,870.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,899.04
|
| Rate for Payer: PHCS Commercial |
$8,977.68
|
| Rate for Payer: United Healthcare All Payer |
$8,229.54
|
|
|
OPTETRAK FEM COMP POST SZ2.5 R
|
Facility
|
IP
|
$15,784.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.02 |
| Max. Negotiated Rate |
$15,153.41 |
| Rate for Payer: Aetna Commercial |
$12,154.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,312.14
|
| Rate for Payer: Cash Price |
$7,892.40
|
| Rate for Payer: Cigna Commercial |
$13,101.38
|
| Rate for Payer: First Health Commercial |
$14,995.56
|
| Rate for Payer: Humana Commercial |
$13,417.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,943.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,735.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,890.62
|
| Rate for Payer: Ohio Health Group HMO |
$11,838.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.29
|
| Rate for Payer: PHCS Commercial |
$15,153.41
|
| Rate for Payer: United Healthcare All Payer |
$13,890.62
|
|
|
OPTETRAK FEM COMP POST SZ2.5 R
|
Facility
|
OP
|
$15,784.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.02 |
| Max. Negotiated Rate |
$15,153.41 |
| Rate for Payer: Aetna Commercial |
$12,154.30
|
| Rate for Payer: Anthem Medicaid |
$5,428.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,312.14
|
| Rate for Payer: Cash Price |
$7,892.40
|
| Rate for Payer: Cigna Commercial |
$13,101.38
|
| Rate for Payer: First Health Commercial |
$14,995.56
|
| Rate for Payer: Humana Commercial |
$13,417.08
|
| Rate for Payer: Humana KY Medicaid |
$5,428.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,483.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,943.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,735.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,537.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,890.62
|
| Rate for Payer: Ohio Health Group HMO |
$11,838.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,156.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.29
|
| Rate for Payer: PHCS Commercial |
$15,153.41
|
| Rate for Payer: United Healthcare All Payer |
$13,890.62
|
|
|
OPTETRAK PEG PATELLA 35MM
|
Facility
|
OP
|
$4,121.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.80 |
| Max. Negotiated Rate |
$3,956.64 |
| Rate for Payer: Aetna Commercial |
$3,173.56
|
| Rate for Payer: Anthem Medicaid |
$1,417.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,214.77
|
| Rate for Payer: Cash Price |
$2,060.75
|
| Rate for Payer: Cigna Commercial |
$3,420.84
|
| Rate for Payer: First Health Commercial |
$3,915.42
|
| Rate for Payer: Humana Commercial |
$3,503.28
|
| Rate for Payer: Humana KY Medicaid |
$1,417.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,431.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,379.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,041.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,445.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,626.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,091.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.66
|
| Rate for Payer: PHCS Commercial |
$3,956.64
|
| Rate for Payer: United Healthcare All Payer |
$3,626.92
|
|
|
OPTETRAK PEG PATELLA 35MM
|
Facility
|
IP
|
$4,121.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.80 |
| Max. Negotiated Rate |
$3,956.64 |
| Rate for Payer: Aetna Commercial |
$3,173.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,214.77
|
| Rate for Payer: Cash Price |
$2,060.75
|
| Rate for Payer: Cigna Commercial |
$3,420.84
|
| Rate for Payer: First Health Commercial |
$3,915.42
|
| Rate for Payer: Humana Commercial |
$3,503.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,379.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,041.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,626.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,091.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.66
|
| Rate for Payer: PHCS Commercial |
$3,956.64
|
| Rate for Payer: United Healthcare All Payer |
$3,626.92
|
|
|
OPTETRAK TIB INSRT SZ 2.5 11MM
|
Facility
|
IP
|
$6,625.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.28 |
| Max. Negotiated Rate |
$6,360.19 |
| Rate for Payer: Aetna Commercial |
$5,101.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,167.66
|
| Rate for Payer: Cash Price |
$3,312.60
|
| Rate for Payer: Cigna Commercial |
$5,498.92
|
| Rate for Payer: First Health Commercial |
$6,293.94
|
| Rate for Payer: Humana Commercial |
$5,631.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,432.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,889.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,987.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,830.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,968.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,325.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,053.81
|
| Rate for Payer: PHCS Commercial |
$6,360.19
|
| Rate for Payer: United Healthcare All Payer |
$5,830.18
|
|
|
OPTETRAK TIB INSRT SZ 2.5 11MM
|
Facility
|
OP
|
$6,625.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.28 |
| Max. Negotiated Rate |
$6,360.19 |
| Rate for Payer: Aetna Commercial |
$5,101.40
|
| Rate for Payer: Anthem Medicaid |
$2,278.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,167.66
|
| Rate for Payer: Cash Price |
$3,312.60
|
| Rate for Payer: Cigna Commercial |
$5,498.92
|
| Rate for Payer: First Health Commercial |
$6,293.94
|
| Rate for Payer: Humana Commercial |
$5,631.42
|
| Rate for Payer: Humana KY Medicaid |
$2,278.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,301.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,432.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,889.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,987.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,324.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,830.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,968.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,325.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$861.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,053.81
|
| Rate for Payer: PHCS Commercial |
$6,360.19
|
| Rate for Payer: United Healthcare All Payer |
$5,830.18
|
|
|
OPTETRAK TIB INS SZ 2.5F/2.5T
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
OPTETRAK TIB INS SZ 2.5F/2.5T
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
OPTI-FIX COLLARED STEM SZ 5.25
|
Facility
|
OP
|
$15,332.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,993.20 |
| Max. Negotiated Rate |
$14,718.99 |
| Rate for Payer: Aetna Commercial |
$11,805.86
|
| Rate for Payer: Anthem Medicaid |
$5,272.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,959.18
|
| Rate for Payer: Cash Price |
$7,666.14
|
| Rate for Payer: Cigna Commercial |
$12,725.79
|
| Rate for Payer: First Health Commercial |
$14,565.67
|
| Rate for Payer: Humana Commercial |
$13,032.44
|
| Rate for Payer: Humana KY Medicaid |
$5,272.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,326.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,572.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,315.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,599.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,378.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,492.41
|
| Rate for Payer: Ohio Health Group HMO |
$11,499.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,066.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,993.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,753.01
|
| Rate for Payer: PHCS Commercial |
$14,718.99
|
| Rate for Payer: United Healthcare All Payer |
$13,492.41
|
|
|
OPTI-FIX COLLARED STEM SZ 5.25
|
Facility
|
IP
|
$15,332.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,993.20 |
| Max. Negotiated Rate |
$14,718.99 |
| Rate for Payer: Aetna Commercial |
$11,805.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,959.18
|
| Rate for Payer: Cash Price |
$7,666.14
|
| Rate for Payer: Cigna Commercial |
$12,725.79
|
| Rate for Payer: First Health Commercial |
$14,565.67
|
| Rate for Payer: Humana Commercial |
$13,032.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,572.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,315.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,599.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,492.41
|
| Rate for Payer: Ohio Health Group HMO |
$11,499.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,066.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,993.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,753.01
|
| Rate for Payer: PHCS Commercial |
$14,718.99
|
| Rate for Payer: United Healthcare All Payer |
$13,492.41
|
|
|
OPTI-FIX XLPE 22 20 DEG 44-45
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 22 20 DEG 44-45
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 22 20 DEG 46-48
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 22 20 DEG 46-48
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 46-48
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 46-48
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 50-54
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 26 20 DEG 50-54
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 46-48
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 46-48
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 50-54
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 50-54
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 56-62
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
