|
RETROCUTTER 5.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 6.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 6.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 6MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 6MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 7.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 7.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 7MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 7MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 8.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 8.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 8MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 8MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 9.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 9.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 9MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETROCUTTER 9MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
RETRO DRILL GUIDE PIN 3MM
|
Facility
|
OP
|
$1,786.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.92 |
| Max. Negotiated Rate |
$1,714.94 |
| Rate for Payer: Aetna Commercial |
$1,375.53
|
| Rate for Payer: Anthem Medicaid |
$614.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.39
|
| Rate for Payer: Cash Price |
$893.20
|
| Rate for Payer: Cigna Commercial |
$1,482.71
|
| Rate for Payer: First Health Commercial |
$1,697.08
|
| Rate for Payer: Humana Commercial |
$1,518.44
|
| Rate for Payer: Humana KY Medicaid |
$614.34
|
| Rate for Payer: Kentucky WC Medicaid |
$620.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,464.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,339.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.62
|
| Rate for Payer: PHCS Commercial |
$1,714.94
|
| Rate for Payer: United Healthcare All Payer |
$1,572.03
|
|
|
RETRO DRILL GUIDE PIN 3MM
|
Facility
|
IP
|
$1,786.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.92 |
| Max. Negotiated Rate |
$1,714.94 |
| Rate for Payer: Aetna Commercial |
$1,375.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.39
|
| Rate for Payer: Cash Price |
$893.20
|
| Rate for Payer: Cigna Commercial |
$1,482.71
|
| Rate for Payer: First Health Commercial |
$1,697.08
|
| Rate for Payer: Humana Commercial |
$1,518.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,464.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,339.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.62
|
| Rate for Payer: PHCS Commercial |
$1,714.94
|
| Rate for Payer: United Healthcare All Payer |
$1,572.03
|
|
|
RETRO DRILL GUIDE PIN 3MM CANN
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem Medicaid |
$636.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Humana KY Medicaid |
$636.56
|
| Rate for Payer: Kentucky WC Medicaid |
$643.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
RETRO DRILL GUIDE PIN 3MM CANN
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
RETROFUSION SCREW 20MM
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
RETROFUSION SCREW 20MM
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
