|
OPTI-FIX XLPE 32 20 DEG 56-62
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 56-62
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 63-74
|
Facility
|
IP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 63-74
|
Facility
|
OP
|
$9,678.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.58 |
| Max. Negotiated Rate |
$9,291.45 |
| Rate for Payer: Aetna Commercial |
$7,452.51
|
| Rate for Payer: Anthem Medicaid |
$3,328.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,549.30
|
| Rate for Payer: Cash Price |
$4,839.29
|
| Rate for Payer: Cigna Commercial |
$8,033.23
|
| Rate for Payer: First Health Commercial |
$9,194.66
|
| Rate for Payer: Humana Commercial |
$8,226.80
|
| Rate for Payer: Humana KY Medicaid |
$3,328.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,362.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,936.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,142.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,903.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,395.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,517.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,258.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,742.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,420.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,678.23
|
| Rate for Payer: PHCS Commercial |
$9,291.45
|
| Rate for Payer: United Healthcare All Payer |
$8,517.16
|
|
|
OPTIFIX XLPE ANVTD 26 +4 46-48
|
Facility
|
OP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem Medicaid |
$3,263.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Humana KY Medicaid |
$3,263.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 26 +4 46-48
|
Facility
|
IP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 50-54
|
Facility
|
IP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 50-54
|
Facility
|
OP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem Medicaid |
$3,263.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Humana KY Medicaid |
$3,263.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 56-62
|
Facility
|
OP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem Medicaid |
$3,263.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Humana KY Medicaid |
$3,263.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 56-62
|
Facility
|
IP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 32 +4 56-62
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
OPTIFIX XLPE ANVTD 32 +4 56-62
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
OPTIFIX XLPE ANVTD 32 +4 63-74
|
Facility
|
IP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 32 +4 63-74
|
Facility
|
OP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem Medicaid |
$3,263.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Humana KY Medicaid |
$3,263.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 36 +4 63-74
|
Facility
|
OP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem Medicaid |
$3,263.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Humana KY Medicaid |
$3,263.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTIFIX XLPE ANVTD 36 +4 63-74
|
Facility
|
IP
|
$9,488.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.64 |
| Max. Negotiated Rate |
$9,109.24 |
| Rate for Payer: Aetna Commercial |
$7,306.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.26
|
| Rate for Payer: Cash Price |
$4,744.39
|
| Rate for Payer: Cigna Commercial |
$7,875.70
|
| Rate for Payer: First Health Commercial |
$9,014.35
|
| Rate for Payer: Humana Commercial |
$8,065.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.14
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.27
|
| Rate for Payer: PHCS Commercial |
$9,109.24
|
| Rate for Payer: United Healthcare All Payer |
$8,350.14
|
|
|
OPTILUME BALLOON DCB 5*24
|
Facility
|
IP
|
$17,072.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,121.75 |
| Max. Negotiated Rate |
$16,389.60 |
| Rate for Payer: Aetna Commercial |
$13,145.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,316.55
|
| Rate for Payer: Cash Price |
$8,536.25
|
| Rate for Payer: Cigna Commercial |
$14,170.17
|
| Rate for Payer: First Health Commercial |
$16,218.88
|
| Rate for Payer: Humana Commercial |
$14,511.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,999.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,599.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,121.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,023.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,804.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,658.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,853.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,780.02
|
| Rate for Payer: PHCS Commercial |
$16,389.60
|
| Rate for Payer: United Healthcare All Payer |
$15,023.80
|
|
|
OPTILUME BALLOON DCB 5*24
|
Facility
|
OP
|
$17,072.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,121.75 |
| Max. Negotiated Rate |
$16,389.60 |
| Rate for Payer: Aetna Commercial |
$13,145.83
|
| Rate for Payer: Anthem Medicaid |
$5,871.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,316.55
|
| Rate for Payer: Cash Price |
$8,536.25
|
| Rate for Payer: Cigna Commercial |
$14,170.17
|
| Rate for Payer: First Health Commercial |
$16,218.88
|
| Rate for Payer: Humana Commercial |
$14,511.62
|
| Rate for Payer: Humana KY Medicaid |
$5,871.23
|
| Rate for Payer: Kentucky WC Medicaid |
$5,930.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,999.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,599.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,121.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,989.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,023.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,804.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,658.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,853.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,780.02
|
| Rate for Payer: PHCS Commercial |
$16,389.60
|
| Rate for Payer: United Healthcare All Payer |
$15,023.80
|
|
|
OPTILUME BALLOON DCB 5*30
|
Facility
|
OP
|
$17,072.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,121.75 |
| Max. Negotiated Rate |
$16,389.60 |
| Rate for Payer: Aetna Commercial |
$13,145.83
|
| Rate for Payer: Anthem Medicaid |
$5,871.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,316.55
|
| Rate for Payer: Cash Price |
$8,536.25
|
| Rate for Payer: Cigna Commercial |
$14,170.17
|
| Rate for Payer: First Health Commercial |
$16,218.88
|
| Rate for Payer: Humana Commercial |
$14,511.62
|
| Rate for Payer: Humana KY Medicaid |
$5,871.23
|
| Rate for Payer: Kentucky WC Medicaid |
$5,930.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,999.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,599.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,121.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,989.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,023.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,804.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,658.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,853.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,780.02
|
| Rate for Payer: PHCS Commercial |
$16,389.60
|
| Rate for Payer: United Healthcare All Payer |
$15,023.80
|
|
|
OPTILUME BALLOON DCB 5*30
|
Facility
|
IP
|
$17,072.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,121.75 |
| Max. Negotiated Rate |
$16,389.60 |
| Rate for Payer: Aetna Commercial |
$13,145.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,316.55
|
| Rate for Payer: Cash Price |
$8,536.25
|
| Rate for Payer: Cigna Commercial |
$14,170.17
|
| Rate for Payer: First Health Commercial |
$16,218.88
|
| Rate for Payer: Humana Commercial |
$14,511.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,999.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,599.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,121.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,023.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,804.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,658.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,853.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,780.02
|
| Rate for Payer: PHCS Commercial |
$16,389.60
|
| Rate for Payer: United Healthcare All Payer |
$15,023.80
|
|
|
OPTILUME BPH 30MM
|
Facility
|
IP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OPTILUME BPH 30MM
|
Facility
|
OP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem Medicaid |
$9,328.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Humana KY Medicaid |
$9,328.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,423.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,515.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OPTILUME BPH 35MM
|
Facility
|
IP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OPTILUME BPH 35MM
|
Facility
|
OP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem Medicaid |
$9,328.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Humana KY Medicaid |
$9,328.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,423.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,515.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OPTILUME BPH 40MM
|
Facility
|
IP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
