|
ARTICULEZE 12/14 40MM SPEC+1.5
|
Facility
|
IP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+15.
|
Facility
|
IP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+15.
|
Facility
|
OP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem Medicaid |
$3,013.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Humana KY Medicaid |
$3,013.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,044.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,074.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC-2
|
Facility
|
IP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC-2
|
Facility
|
OP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem Medicaid |
$3,013.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Humana KY Medicaid |
$3,013.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,044.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,074.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+5
|
Facility
|
OP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem Medicaid |
$3,013.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Humana KY Medicaid |
$3,013.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,044.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,074.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+5
|
Facility
|
IP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+8.5
|
Facility
|
OP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem Medicaid |
$3,092.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Humana KY Medicaid |
$3,092.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,123.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 40MM SPEC+8.5
|
Facility
|
IP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+12
|
Facility
|
OP
|
$8,099.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.97 |
| Max. Negotiated Rate |
$7,775.81 |
| Rate for Payer: Aetna Commercial |
$6,236.85
|
| Rate for Payer: Anthem Medicaid |
$2,785.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,317.84
|
| Rate for Payer: Cash Price |
$4,049.90
|
| Rate for Payer: Cigna Commercial |
$6,722.83
|
| Rate for Payer: First Health Commercial |
$7,694.81
|
| Rate for Payer: Humana Commercial |
$6,884.83
|
| Rate for Payer: Humana KY Medicaid |
$2,785.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,813.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,641.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,977.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,127.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,074.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,510.94
|
| Rate for Payer: PHCS Commercial |
$7,775.81
|
| Rate for Payer: United Healthcare All Payer |
$7,127.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+12
|
Facility
|
IP
|
$8,099.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.97 |
| Max. Negotiated Rate |
$7,775.81 |
| Rate for Payer: Aetna Commercial |
$6,236.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,317.84
|
| Rate for Payer: Cash Price |
$4,049.90
|
| Rate for Payer: Cigna Commercial |
$6,722.83
|
| Rate for Payer: First Health Commercial |
$7,694.81
|
| Rate for Payer: Humana Commercial |
$6,884.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,641.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,977.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,127.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,074.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,510.94
|
| Rate for Payer: PHCS Commercial |
$7,775.81
|
| Rate for Payer: United Healthcare All Payer |
$7,127.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+1.5
|
Facility
|
IP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+1.5
|
Facility
|
OP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem Medicaid |
$3,092.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Humana KY Medicaid |
$3,092.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,123.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 44MM SPEC-2
|
Facility
|
OP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem Medicaid |
$3,092.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Humana KY Medicaid |
$3,092.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,123.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 44MM SPEC-2
|
Facility
|
IP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+5
|
Facility
|
OP
|
$8,099.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.97 |
| Max. Negotiated Rate |
$7,775.81 |
| Rate for Payer: Aetna Commercial |
$6,236.85
|
| Rate for Payer: Anthem Medicaid |
$2,785.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,317.84
|
| Rate for Payer: Cash Price |
$4,049.90
|
| Rate for Payer: Cigna Commercial |
$6,722.83
|
| Rate for Payer: First Health Commercial |
$7,694.81
|
| Rate for Payer: Humana Commercial |
$6,884.83
|
| Rate for Payer: Humana KY Medicaid |
$2,785.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,813.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,641.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,977.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,127.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,074.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,510.94
|
| Rate for Payer: PHCS Commercial |
$7,775.81
|
| Rate for Payer: United Healthcare All Payer |
$7,127.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+5
|
Facility
|
IP
|
$8,099.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.97 |
| Max. Negotiated Rate |
$7,775.81 |
| Rate for Payer: Aetna Commercial |
$6,236.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,317.84
|
| Rate for Payer: Cash Price |
$4,049.90
|
| Rate for Payer: Cigna Commercial |
$6,722.83
|
| Rate for Payer: First Health Commercial |
$7,694.81
|
| Rate for Payer: Humana Commercial |
$6,884.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,641.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,977.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,127.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,074.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,510.94
|
| Rate for Payer: PHCS Commercial |
$7,775.81
|
| Rate for Payer: United Healthcare All Payer |
$7,127.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+8.5
|
Facility
|
OP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem Medicaid |
$3,092.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Humana KY Medicaid |
$3,092.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,123.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+8.5
|
Facility
|
IP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICUL/EZE FEM HEAD 32MM 13
|
Facility
|
IP
|
$4,633.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$4,448.54 |
| Rate for Payer: Aetna Commercial |
$3,568.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.44
|
| Rate for Payer: Cash Price |
$2,316.95
|
| Rate for Payer: Cigna Commercial |
$3,846.14
|
| Rate for Payer: First Health Commercial |
$4,402.20
|
| Rate for Payer: Humana Commercial |
$3,938.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.51
|
| Rate for Payer: PHCS Commercial |
$4,448.54
|
| Rate for Payer: United Healthcare All Payer |
$4,077.83
|
|
|
ARTICUL/EZE FEM HEAD 32MM 13
|
Facility
|
OP
|
$4,633.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$4,448.54 |
| Rate for Payer: Aetna Commercial |
$3,568.10
|
| Rate for Payer: Anthem Medicaid |
$1,593.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.44
|
| Rate for Payer: Cash Price |
$2,316.95
|
| Rate for Payer: Cigna Commercial |
$3,846.14
|
| Rate for Payer: First Health Commercial |
$4,402.20
|
| Rate for Payer: Humana Commercial |
$3,938.82
|
| Rate for Payer: Humana KY Medicaid |
$1,593.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.51
|
| Rate for Payer: PHCS Commercial |
$4,448.54
|
| Rate for Payer: United Healthcare All Payer |
$4,077.83
|
|
|
ARTICUL/EZE HIP BALL 32MM 1
|
Facility
|
IP
|
$4,633.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$4,448.54 |
| Rate for Payer: Aetna Commercial |
$3,568.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.44
|
| Rate for Payer: Cash Price |
$2,316.95
|
| Rate for Payer: Cigna Commercial |
$3,846.14
|
| Rate for Payer: First Health Commercial |
$4,402.20
|
| Rate for Payer: Humana Commercial |
$3,938.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.51
|
| Rate for Payer: PHCS Commercial |
$4,448.54
|
| Rate for Payer: United Healthcare All Payer |
$4,077.83
|
|
|
ARTICUL/EZE HIP BALL 32MM 1
|
Facility
|
OP
|
$4,633.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.41 |
| Max. Negotiated Rate |
$4,448.54 |
| Rate for Payer: Aetna Commercial |
$3,568.10
|
| Rate for Payer: Anthem Medicaid |
$1,593.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,614.44
|
| Rate for Payer: Cash Price |
$2,316.95
|
| Rate for Payer: Cigna Commercial |
$3,846.14
|
| Rate for Payer: First Health Commercial |
$4,402.20
|
| Rate for Payer: Humana Commercial |
$3,938.82
|
| Rate for Payer: Humana KY Medicaid |
$1,593.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,799.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,419.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,077.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,475.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.51
|
| Rate for Payer: PHCS Commercial |
$4,448.54
|
| Rate for Payer: United Healthcare All Payer |
$4,077.83
|
|
|
ARTICUL/EZE HIP BALL 32MM 17
|
Facility
|
OP
|
$4,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.09 |
| Max. Negotiated Rate |
$4,379.73 |
| Rate for Payer: Aetna Commercial |
$3,512.91
|
| Rate for Payer: Anthem Medicaid |
$1,568.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.53
|
| Rate for Payer: Cash Price |
$2,281.11
|
| Rate for Payer: Cigna Commercial |
$3,786.64
|
| Rate for Payer: First Health Commercial |
$4,334.11
|
| Rate for Payer: Humana Commercial |
$3,877.89
|
| Rate for Payer: Humana KY Medicaid |
$1,568.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,584.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.29
|
| Rate for Payer: PHCS Commercial |
$4,379.73
|
| Rate for Payer: United Healthcare All Payer |
$4,014.75
|
|
|
ARTICUL/EZE HIP BALL 32MM 17
|
Facility
|
IP
|
$4,562.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.09 |
| Max. Negotiated Rate |
$4,379.73 |
| Rate for Payer: Aetna Commercial |
$3,512.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.53
|
| Rate for Payer: Cash Price |
$2,281.11
|
| Rate for Payer: Cigna Commercial |
$3,786.64
|
| Rate for Payer: First Health Commercial |
$4,334.11
|
| Rate for Payer: Humana Commercial |
$3,877.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.29
|
| Rate for Payer: PHCS Commercial |
$4,379.73
|
| Rate for Payer: United Healthcare All Payer |
$4,014.75
|
|
