|
BARRX 360 EXPRESS BALLOON CATH
|
Facility
|
IP
|
$12,428.65
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,615.72 |
| Max. Negotiated Rate |
$11,931.50 |
| Rate for Payer: Aetna Commercial |
$9,570.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,694.35
|
| Rate for Payer: Cash Price |
$6,214.32
|
| Rate for Payer: Cigna Commercial |
$10,315.78
|
| Rate for Payer: First Health Commercial |
$11,807.22
|
| Rate for Payer: Humana Commercial |
$10,564.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,191.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,172.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,728.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,937.21
|
| Rate for Payer: Ohio Health Group HMO |
$9,321.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,852.88
|
| Rate for Payer: PHCS Commercial |
$11,931.50
|
| Rate for Payer: United Healthcare All Payer |
$10,937.21
|
|
|
BASE PLATE ASSEMBLY IJS-E
|
Facility
|
OP
|
$25,612.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.60 |
| Max. Negotiated Rate |
$24,587.81 |
| Rate for Payer: Aetna Commercial |
$19,721.47
|
| Rate for Payer: Anthem Medicaid |
$8,808.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,977.59
|
| Rate for Payer: Cash Price |
$12,806.15
|
| Rate for Payer: Cigna Commercial |
$21,258.21
|
| Rate for Payer: First Health Commercial |
$24,331.68
|
| Rate for Payer: Humana Commercial |
$21,770.46
|
| Rate for Payer: Humana KY Medicaid |
$8,808.07
|
| Rate for Payer: Kentucky WC Medicaid |
$8,897.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,002.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,901.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,683.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,984.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,538.82
|
| Rate for Payer: Ohio Health Group HMO |
$19,209.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,122.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,329.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,939.81
|
| Rate for Payer: PHCS Commercial |
$24,587.81
|
| Rate for Payer: United Healthcare All Payer |
$22,538.82
|
|
|
BASE PLATE ASSEMBLY IJS-E
|
Facility
|
IP
|
$25,612.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.60 |
| Max. Negotiated Rate |
$24,587.81 |
| Rate for Payer: Aetna Commercial |
$19,721.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,977.59
|
| Rate for Payer: Cash Price |
$12,806.15
|
| Rate for Payer: Cigna Commercial |
$21,258.21
|
| Rate for Payer: First Health Commercial |
$24,331.68
|
| Rate for Payer: Humana Commercial |
$21,770.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,002.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,901.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,683.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,538.82
|
| Rate for Payer: Ohio Health Group HMO |
$19,209.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,122.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,329.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,939.81
|
| Rate for Payer: PHCS Commercial |
$24,587.81
|
| Rate for Payer: United Healthcare All Payer |
$22,538.82
|
|
|
BASEPLATE MB POST 24MM
|
Facility
|
IP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB POST 24MM
|
Facility
|
OP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem Medicaid |
$5,344.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Humana KY Medicaid |
$5,344.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,398.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,451.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB POST 28MM
|
Facility
|
OP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem Medicaid |
$5,344.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Humana KY Medicaid |
$5,344.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,398.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,451.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB POST 28MM
|
Facility
|
IP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB SCREW 24MM
|
Facility
|
IP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB SCREW 24MM
|
Facility
|
OP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem Medicaid |
$5,344.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Humana KY Medicaid |
$5,344.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,398.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,451.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB SCREW 28MM
|
Facility
|
IP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MB SCREW 28MM
|
Facility
|
OP
|
$15,540.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem Medicaid |
$5,344.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Humana KY Medicaid |
$5,344.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,398.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,451.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
BASEPLATE MOD 24+2 LAT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MOD 24+2 LAT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MOD 24+4 LAT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MOD 24+4 LAT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MOD 28+2 LAT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MOD 28+2 LAT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
|
|
BASEPLATE MOD 28+4 LAT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MOD 28+4 LAT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MODULAR 24MM
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MODULAR 24MM
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MODULAR 28MM
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASEPLATE MODULAR 28MM
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
BASIC COMP AUDIOLOGY
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 92557
|
| Hospital Charge Code |
47000012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem Medicaid |
$113.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Humana KY Medicaid |
$113.83
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$114.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.61
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
BASIC COMP AUDIOLOGY
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 92557
|
| Hospital Charge Code |
47000012
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.18
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.61
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
