|
REFL PERIPHERAL HOLE 78MM 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 78MM 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 80MM 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 80MM 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 XLPE 28 20 +4 46-48
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 28 20 +4 46-48
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 28 20 +4 50-52
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 28 20 +4 50-52
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 28 20 +4 54-56
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 28 20 +4 54-56
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 54-56
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 54-56
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 58-60
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 58-60
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 62-64
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 62-64
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 66-68
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 66-68
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 70-76
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 32 20 +4 70-76
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 28 46-48
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 28 46-48
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 28 50-52
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 28 50-52
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 32 54-56
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
