REF LNR 32ID 66-68OD 20 DEGSZJ
|
Facility
|
OP
|
$5,573.65
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$724.57 |
Max. Negotiated Rate |
$5,350.70 |
Rate for Payer: Aetna Commercial |
$4,291.71
|
Rate for Payer: Anthem Medicaid |
$1,916.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
Rate for Payer: Cash Price |
$2,786.82
|
Rate for Payer: Cigna Commercial |
$4,626.13
|
Rate for Payer: First Health Commercial |
$5,294.97
|
Rate for Payer: Humana Commercial |
$4,737.60
|
Rate for Payer: Humana KY Medicaid |
$1,916.78
|
Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
Rate for Payer: PHCS Commercial |
$5,350.70
|
Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
REF LNR 32ID 70-76OD 20 DEGSZK
|
Facility
|
IP
|
$5,573.65
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$724.57 |
Max. Negotiated Rate |
$5,350.70 |
Rate for Payer: Aetna Commercial |
$4,291.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
Rate for Payer: Cash Price |
$2,786.82
|
Rate for Payer: Cigna Commercial |
$4,626.13
|
Rate for Payer: First Health Commercial |
$5,294.97
|
Rate for Payer: Humana Commercial |
$4,737.60
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
Rate for Payer: PHCS Commercial |
$5,350.70
|
Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
REF LNR 32ID 70-76OD 20 DEGSZK
|
Facility
|
OP
|
$5,573.65
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$724.57 |
Max. Negotiated Rate |
$5,350.70 |
Rate for Payer: Aetna Commercial |
$4,291.71
|
Rate for Payer: Anthem Medicaid |
$1,916.78
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
Rate for Payer: Cash Price |
$2,786.82
|
Rate for Payer: Cigna Commercial |
$4,626.13
|
Rate for Payer: First Health Commercial |
$5,294.97
|
Rate for Payer: Humana Commercial |
$4,737.60
|
Rate for Payer: Humana KY Medicaid |
$1,916.78
|
Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
Rate for Payer: PHCS Commercial |
$5,350.70
|
Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
REF LOCKING HEAD PEG
|
Facility
|
OP
|
$1,836.85
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$238.79 |
Max. Negotiated Rate |
$1,763.38 |
Rate for Payer: Aetna Commercial |
$1,414.37
|
Rate for Payer: Anthem Medicaid |
$631.69
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,432.74
|
Rate for Payer: Cash Price |
$918.42
|
Rate for Payer: Cigna Commercial |
$1,524.59
|
Rate for Payer: First Health Commercial |
$1,745.01
|
Rate for Payer: Humana Commercial |
$1,561.32
|
Rate for Payer: Humana KY Medicaid |
$631.69
|
Rate for Payer: Kentucky WC Medicaid |
$638.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,506.22
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,355.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$551.06
|
Rate for Payer: Molina Healthcare Medicaid |
$644.37
|
Rate for Payer: Ohio Health Choice Commercial |
$1,616.43
|
Rate for Payer: Ohio Health Group HMO |
$1,377.64
|
Rate for Payer: Ohio Health Group PPO Differential |
$367.37
|
Rate for Payer: Ohio Health Group PPO No Differential |
$238.79
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.42
|
Rate for Payer: PHCS Commercial |
$1,763.38
|
Rate for Payer: United Healthcare All Payer |
$1,616.43
|
|
REF LOCKING HEAD PEG
|
Facility
|
IP
|
$1,836.85
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$238.79 |
Max. Negotiated Rate |
$1,763.38 |
Rate for Payer: Aetna Commercial |
$1,414.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,432.74
|
Rate for Payer: Cash Price |
$918.42
|
Rate for Payer: Cigna Commercial |
$1,524.59
|
Rate for Payer: First Health Commercial |
$1,745.01
|
Rate for Payer: Humana Commercial |
$1,561.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,506.22
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,355.60
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$551.06
|
Rate for Payer: Ohio Health Choice Commercial |
$1,616.43
|
Rate for Payer: Ohio Health Group HMO |
$1,377.64
|
Rate for Payer: Ohio Health Group PPO Differential |
$367.37
|
Rate for Payer: Ohio Health Group PPO No Differential |
$238.79
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.42
|
Rate for Payer: PHCS Commercial |
$1,763.38
|
Rate for Payer: United Healthcare All Payer |
$1,616.43
|
|
REF LOCKING HEAD PEG 25MM
|
Facility
|
OP
|
$2,130.32
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$276.94 |
Max. Negotiated Rate |
$2,045.11 |
Rate for Payer: Aetna Commercial |
$1,640.35
|
Rate for Payer: Anthem Medicaid |
$732.62
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.65
|
Rate for Payer: Cash Price |
$1,065.16
|
Rate for Payer: Cigna Commercial |
$1,768.17
|
Rate for Payer: First Health Commercial |
$2,023.80
|
Rate for Payer: Humana Commercial |
$1,810.77
|
Rate for Payer: Humana KY Medicaid |
$732.62
|
Rate for Payer: Kentucky WC Medicaid |
$740.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,572.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$639.10
|
Rate for Payer: Molina Healthcare Medicaid |
$747.32
|
Rate for Payer: Ohio Health Choice Commercial |
$1,874.68
|
Rate for Payer: Ohio Health Group HMO |
$1,597.74
|
Rate for Payer: Ohio Health Group PPO Differential |
$426.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$276.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.40
|
Rate for Payer: PHCS Commercial |
$2,045.11
|
Rate for Payer: United Healthcare All Payer |
$1,874.68
|
|
REF LOCKING HEAD PEG 25MM
|
Facility
|
IP
|
$2,130.32
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$276.94 |
Max. Negotiated Rate |
$2,045.11 |
Rate for Payer: Aetna Commercial |
$1,640.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.65
|
Rate for Payer: Cash Price |
$1,065.16
|
Rate for Payer: Cigna Commercial |
$1,768.17
|
Rate for Payer: First Health Commercial |
$2,023.80
|
Rate for Payer: Humana Commercial |
$1,810.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,572.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$639.10
|
Rate for Payer: Ohio Health Choice Commercial |
$1,874.68
|
Rate for Payer: Ohio Health Group HMO |
$1,597.74
|
Rate for Payer: Ohio Health Group PPO Differential |
$426.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$276.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.40
|
Rate for Payer: PHCS Commercial |
$2,045.11
|
Rate for Payer: United Healthcare All Payer |
$1,874.68
|
|
REF LOCKING HEAD PEG 35MM
|
Facility
|
OP
|
$2,130.32
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$276.94 |
Max. Negotiated Rate |
$2,045.11 |
Rate for Payer: Aetna Commercial |
$1,640.35
|
Rate for Payer: Anthem Medicaid |
$732.62
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.65
|
Rate for Payer: Cash Price |
$1,065.16
|
Rate for Payer: Cigna Commercial |
$1,768.17
|
Rate for Payer: First Health Commercial |
$2,023.80
|
Rate for Payer: Humana Commercial |
$1,810.77
|
Rate for Payer: Humana KY Medicaid |
$732.62
|
Rate for Payer: Kentucky WC Medicaid |
$740.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,572.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$639.10
|
Rate for Payer: Molina Healthcare Medicaid |
$747.32
|
Rate for Payer: Ohio Health Choice Commercial |
$1,874.68
|
Rate for Payer: Ohio Health Group HMO |
$1,597.74
|
Rate for Payer: Ohio Health Group PPO Differential |
$426.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$276.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.40
|
Rate for Payer: PHCS Commercial |
$2,045.11
|
Rate for Payer: United Healthcare All Payer |
$1,874.68
|
|
REF LOCKING HEAD PEG 35MM
|
Facility
|
IP
|
$2,130.32
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$276.94 |
Max. Negotiated Rate |
$2,045.11 |
Rate for Payer: Aetna Commercial |
$1,640.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.65
|
Rate for Payer: Cash Price |
$1,065.16
|
Rate for Payer: Cigna Commercial |
$1,768.17
|
Rate for Payer: First Health Commercial |
$2,023.80
|
Rate for Payer: Humana Commercial |
$1,810.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.86
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,572.18
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$639.10
|
Rate for Payer: Ohio Health Choice Commercial |
$1,874.68
|
Rate for Payer: Ohio Health Group HMO |
$1,597.74
|
Rate for Payer: Ohio Health Group PPO Differential |
$426.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$276.94
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.40
|
Rate for Payer: PHCS Commercial |
$2,045.11
|
Rate for Payer: United Healthcare All Payer |
$1,874.68
|
|
REFL PERIPHERAL HOLE 62MM HA
|
Facility
|
IP
|
$11,152.43
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,449.82 |
Max. Negotiated Rate |
$10,706.33 |
Rate for Payer: Aetna Commercial |
$8,587.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
Rate for Payer: Cash Price |
$5,576.21
|
Rate for Payer: Cigna Commercial |
$9,256.52
|
Rate for Payer: First Health Commercial |
$10,594.81
|
Rate for Payer: Humana Commercial |
$9,479.57
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
Rate for Payer: PHCS Commercial |
$10,706.33
|
Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
REFL PERIPHERAL HOLE 62MM HA
|
Facility
|
OP
|
$11,152.43
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,449.82 |
Max. Negotiated Rate |
$10,706.33 |
Rate for Payer: Aetna Commercial |
$8,587.37
|
Rate for Payer: Anthem Medicaid |
$3,835.32
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
Rate for Payer: Cash Price |
$5,576.21
|
Rate for Payer: Cigna Commercial |
$9,256.52
|
Rate for Payer: First Health Commercial |
$10,594.81
|
Rate for Payer: Humana Commercial |
$9,479.57
|
Rate for Payer: Humana KY Medicaid |
$3,835.32
|
Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
Rate for Payer: PHCS Commercial |
$10,706.33
|
Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
REFL PERIPHERAL HOLE 64MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 64MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 66MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 66MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 68MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 68MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 70MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 70MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 72MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 72MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 74MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 74MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 76MM HA
|
Facility
|
IP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|
REFL PERIPHERAL HOLE 76MM HA
|
Facility
|
OP
|
$12,247.61
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,592.19 |
Max. Negotiated Rate |
$11,757.71 |
Rate for Payer: Aetna Commercial |
$9,430.66
|
Rate for Payer: Anthem Medicaid |
$4,211.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,553.14
|
Rate for Payer: Cash Price |
$6,123.80
|
Rate for Payer: Cigna Commercial |
$10,165.52
|
Rate for Payer: First Health Commercial |
$11,635.23
|
Rate for Payer: Humana Commercial |
$10,410.47
|
Rate for Payer: Humana KY Medicaid |
$4,211.95
|
Rate for Payer: Kentucky WC Medicaid |
$4,254.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,043.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,038.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.28
|
Rate for Payer: Molina Healthcare Medicaid |
$4,296.46
|
Rate for Payer: Ohio Health Choice Commercial |
$10,777.90
|
Rate for Payer: Ohio Health Group HMO |
$9,185.71
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,449.52
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.19
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.76
|
Rate for Payer: PHCS Commercial |
$11,757.71
|
Rate for Payer: United Healthcare All Payer |
$10,777.90
|
|