|
REF LNR 32ID 62-64OD 20 DEGSZH
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 66-68OD 20 DEGSZJ
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 66-68OD 20 DEGSZJ
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 70-76OD 20 DEGSZK
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 70-76OD 20 DEGSZK
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LOCKING HEAD PEG
|
Facility
|
IP
|
$1,828.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.57 |
| Max. Negotiated Rate |
$1,755.44 |
| Rate for Payer: Aetna Commercial |
$1,408.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.29
|
| Rate for Payer: Cash Price |
$914.29
|
| Rate for Payer: Cigna Commercial |
$1,517.72
|
| Rate for Payer: First Health Commercial |
$1,737.15
|
| Rate for Payer: Humana Commercial |
$1,554.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,462.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,590.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,261.72
|
| Rate for Payer: PHCS Commercial |
$1,755.44
|
| Rate for Payer: United Healthcare All Payer |
$1,609.15
|
|
|
REF LOCKING HEAD PEG
|
Facility
|
OP
|
$1,828.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.57 |
| Max. Negotiated Rate |
$1,755.44 |
| Rate for Payer: Aetna Commercial |
$1,408.01
|
| Rate for Payer: Anthem Medicaid |
$628.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.29
|
| Rate for Payer: Cash Price |
$914.29
|
| Rate for Payer: Cigna Commercial |
$1,517.72
|
| Rate for Payer: First Health Commercial |
$1,737.15
|
| Rate for Payer: Humana Commercial |
$1,554.29
|
| Rate for Payer: Humana KY Medicaid |
$628.85
|
| Rate for Payer: Kentucky WC Medicaid |
$635.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,462.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,590.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,261.72
|
| Rate for Payer: PHCS Commercial |
$1,755.44
|
| Rate for Payer: United Healthcare All Payer |
$1,609.15
|
|
|
REF LOCKING HEAD PEG 25MM
|
Facility
|
OP
|
$2,147.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.16 |
| Max. Negotiated Rate |
$2,061.32 |
| Rate for Payer: Aetna Commercial |
$1,653.35
|
| Rate for Payer: Anthem Medicaid |
$738.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,674.82
|
| Rate for Payer: Cash Price |
$1,073.61
|
| Rate for Payer: Cigna Commercial |
$1,782.18
|
| Rate for Payer: First Health Commercial |
$2,039.85
|
| Rate for Payer: Humana Commercial |
$1,825.13
|
| Rate for Payer: Humana KY Medicaid |
$738.43
|
| Rate for Payer: Kentucky WC Medicaid |
$745.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,760.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,584.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$753.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,889.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,610.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,868.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.57
|
| Rate for Payer: PHCS Commercial |
$2,061.32
|
| Rate for Payer: United Healthcare All Payer |
$1,889.54
|
|
|
REF LOCKING HEAD PEG 25MM
|
Facility
|
IP
|
$2,147.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.16 |
| Max. Negotiated Rate |
$2,061.32 |
| Rate for Payer: Aetna Commercial |
$1,653.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,674.82
|
| Rate for Payer: Cash Price |
$1,073.61
|
| Rate for Payer: Cigna Commercial |
$1,782.18
|
| Rate for Payer: First Health Commercial |
$2,039.85
|
| Rate for Payer: Humana Commercial |
$1,825.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,760.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,584.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,889.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,610.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,868.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.57
|
| Rate for Payer: PHCS Commercial |
$2,061.32
|
| Rate for Payer: United Healthcare All Payer |
$1,889.54
|
|
|
REF LOCKING HEAD PEG 35MM
|
Facility
|
IP
|
$2,147.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.16 |
| Max. Negotiated Rate |
$2,061.32 |
| Rate for Payer: Aetna Commercial |
$1,653.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,674.82
|
| Rate for Payer: Cash Price |
$1,073.61
|
| Rate for Payer: Cigna Commercial |
$1,782.18
|
| Rate for Payer: First Health Commercial |
$2,039.85
|
| Rate for Payer: Humana Commercial |
$1,825.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,760.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,584.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,889.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,610.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,868.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.57
|
| Rate for Payer: PHCS Commercial |
$2,061.32
|
| Rate for Payer: United Healthcare All Payer |
$1,889.54
|
|
|
REF LOCKING HEAD PEG 35MM
|
Facility
|
OP
|
$2,147.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.16 |
| Max. Negotiated Rate |
$2,061.32 |
| Rate for Payer: Aetna Commercial |
$1,653.35
|
| Rate for Payer: Anthem Medicaid |
$738.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,674.82
|
| Rate for Payer: Cash Price |
$1,073.61
|
| Rate for Payer: Cigna Commercial |
$1,782.18
|
| Rate for Payer: First Health Commercial |
$2,039.85
|
| Rate for Payer: Humana Commercial |
$1,825.13
|
| Rate for Payer: Humana KY Medicaid |
$738.43
|
| Rate for Payer: Kentucky WC Medicaid |
$745.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,760.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,584.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$753.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,889.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,610.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,868.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.57
|
| Rate for Payer: PHCS Commercial |
$2,061.32
|
| Rate for Payer: United Healthcare All Payer |
$1,889.54
|
|
|
REFL PERIPHERAL HOLE 62MM HA
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL PERIPHERAL HOLE 62MM HA
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL PERIPHERAL HOLE 64MM HA
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 64MM HA
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 66MM HA
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 66MM HA
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 68MM HA
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 68MM HA
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 70MM HA
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 70MM HA
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 72MM HA
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 72MM HA
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 74MM HA
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL PERIPHERAL HOLE 74MM HA
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
