|
PKR INSERT X 3 # 4 RM/ LL 12MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 4 RM/ LL 12MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 4 RM/LL 8MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 4 RM/LL 8MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 4 RM/LL 9MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 4 RM/LL 9MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 5 LM/RL-10
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 5 LM/RL-10
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 #5 LM/RL-12
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 #5 LM/RL-12
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 5 LM/RL-8
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 5 LM/RL-8
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 5 LM/RL-9
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X 3 # 5 LM/RL-9
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL-10MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL-10MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL-12MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL-12MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL 8MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL 8MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL 9MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 # 5 RM/LL 9MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 #6 LM/RL -10
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 #6 LM/RL -10
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
PKR INSERT X3 #6 LM/RL -12
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
