|
SROM EXT TIB STEM 15*150MM
|
Facility
|
IP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 15*150MM
|
Facility
|
OP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem Medicaid |
$2,316.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Humana KY Medicaid |
$2,316.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 17*100MM
|
Facility
|
IP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 17*100MM
|
Facility
|
OP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem Medicaid |
$2,316.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Humana KY Medicaid |
$2,316.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 19*100MM
|
Facility
|
OP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem Medicaid |
$2,316.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Humana KY Medicaid |
$2,316.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 19*100MM
|
Facility
|
IP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 21*100MM
|
Facility
|
IP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM EXT TIB STEM 21*100MM
|
Facility
|
OP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem Medicaid |
$2,316.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Humana KY Medicaid |
$2,316.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM FEMORAL SLEEVE 18F LRG
|
Facility
|
OP
|
$12,133.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,577.29 |
| Max. Negotiated Rate |
$11,647.68 |
| Rate for Payer: Aetna Commercial |
$9,342.41
|
| Rate for Payer: Anthem Medicaid |
$4,172.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,463.74
|
| Rate for Payer: Cash Price |
$6,066.50
|
| Rate for Payer: Cigna Commercial |
$10,070.39
|
| Rate for Payer: First Health Commercial |
$11,526.35
|
| Rate for Payer: Humana Commercial |
$10,313.05
|
| Rate for Payer: Humana KY Medicaid |
$4,172.54
|
| Rate for Payer: Kentucky WC Medicaid |
$4,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,949.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,954.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,639.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,256.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,677.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,761.23
|
| Rate for Payer: PHCS Commercial |
$11,647.68
|
| Rate for Payer: United Healthcare All Payer |
$10,677.04
|
|
|
SROM FEMORAL SLEEVE 18F LRG
|
Facility
|
IP
|
$12,133.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,577.29 |
| Max. Negotiated Rate |
$11,647.68 |
| Rate for Payer: Aetna Commercial |
$9,342.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,463.74
|
| Rate for Payer: Cash Price |
$6,066.50
|
| Rate for Payer: Cigna Commercial |
$10,070.39
|
| Rate for Payer: First Health Commercial |
$11,526.35
|
| Rate for Payer: Humana Commercial |
$10,313.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,949.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,954.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,639.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,677.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,761.23
|
| Rate for Payer: PHCS Commercial |
$11,647.68
|
| Rate for Payer: United Healthcare All Payer |
$10,677.04
|
|
|
SROM FEMORAL SLEEVE 20MM
|
Facility
|
IP
|
$5,523.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$5,302.12 |
| Rate for Payer: Aetna Commercial |
$4,252.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,307.97
|
| Rate for Payer: Cash Price |
$2,761.52
|
| Rate for Payer: Cigna Commercial |
$4,584.12
|
| Rate for Payer: First Health Commercial |
$5,246.89
|
| Rate for Payer: Humana Commercial |
$4,694.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,528.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,076.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,860.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,142.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.14
|
| Rate for Payer: PHCS Commercial |
$5,302.12
|
| Rate for Payer: United Healthcare All Payer |
$4,860.28
|
|
|
SROM FEMORAL SLEEVE 20MM
|
Facility
|
OP
|
$5,523.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$5,302.12 |
| Rate for Payer: Aetna Commercial |
$4,252.74
|
| Rate for Payer: Anthem Medicaid |
$1,899.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,307.97
|
| Rate for Payer: Cash Price |
$2,761.52
|
| Rate for Payer: Cigna Commercial |
$4,584.12
|
| Rate for Payer: First Health Commercial |
$5,246.89
|
| Rate for Payer: Humana Commercial |
$4,694.58
|
| Rate for Payer: Humana KY Medicaid |
$1,899.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,918.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,528.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,076.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,937.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,860.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,142.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.14
|
| Rate for Payer: PHCS Commercial |
$5,302.12
|
| Rate for Payer: United Healthcare All Payer |
$4,860.28
|
|
|
S-ROM FEMORAL STEM RT LONG
|
Facility
|
OP
|
$32,430.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,215.96 |
| Max. Negotiated Rate |
$31,133.28 |
| Rate for Payer: Aetna Commercial |
$24,971.48
|
| Rate for Payer: Anthem Medicaid |
$11,152.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,295.79
|
| Rate for Payer: Cash Price |
$16,215.25
|
| Rate for Payer: Cigna Commercial |
$26,917.32
|
| Rate for Payer: First Health Commercial |
$30,808.98
|
| Rate for Payer: Humana Commercial |
$27,565.92
|
| Rate for Payer: Humana KY Medicaid |
$11,152.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11,266.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,593.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,933.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,729.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,376.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,538.84
|
| Rate for Payer: Ohio Health Group HMO |
$24,322.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,486.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,215.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,053.46
|
| Rate for Payer: PHCS Commercial |
$31,133.28
|
| Rate for Payer: United Healthcare All Payer |
$28,538.84
|
|
|
S-ROM FEMORAL STEM RT LONG
|
Facility
|
IP
|
$32,430.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,215.96 |
| Max. Negotiated Rate |
$31,133.28 |
| Rate for Payer: Aetna Commercial |
$24,971.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,295.79
|
| Rate for Payer: Cash Price |
$16,215.25
|
| Rate for Payer: Cigna Commercial |
$26,917.32
|
| Rate for Payer: First Health Commercial |
$30,808.98
|
| Rate for Payer: Humana Commercial |
$27,565.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,593.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,933.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,729.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,538.84
|
| Rate for Payer: Ohio Health Group HMO |
$24,322.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,486.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,215.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,053.46
|
| Rate for Payer: PHCS Commercial |
$31,133.28
|
| Rate for Payer: United Healthcare All Payer |
$28,538.84
|
|
|
SROM FEM STM 18*13*215 LT LNG
|
Facility
|
IP
|
$26,554.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,452.02 |
| Max. Negotiated Rate |
$25,491.84 |
| Rate for Payer: Aetna Commercial |
$20,446.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,712.12
|
| Rate for Payer: Cash Price |
$13,277.00
|
| Rate for Payer: Cigna Commercial |
$22,039.82
|
| Rate for Payer: First Health Commercial |
$25,226.30
|
| Rate for Payer: Humana Commercial |
$22,570.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,774.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,596.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,966.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,915.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,310.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.74
|
| Rate for Payer: PHCS Commercial |
$25,491.84
|
| Rate for Payer: United Healthcare All Payer |
$23,367.52
|
|
|
SROM FEM STM 18*13*215 LT LNG
|
Facility
|
OP
|
$26,554.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,452.02 |
| Max. Negotiated Rate |
$25,491.84 |
| Rate for Payer: Aetna Commercial |
$20,446.58
|
| Rate for Payer: Anthem Medicaid |
$9,131.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,712.12
|
| Rate for Payer: Cash Price |
$13,277.00
|
| Rate for Payer: Cigna Commercial |
$22,039.82
|
| Rate for Payer: First Health Commercial |
$25,226.30
|
| Rate for Payer: Humana Commercial |
$22,570.90
|
| Rate for Payer: Humana KY Medicaid |
$9,131.92
|
| Rate for Payer: Kentucky WC Medicaid |
$9,224.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,774.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,596.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,966.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,315.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,367.52
|
| Rate for Payer: Ohio Health Group HMO |
$19,915.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,310.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.74
|
| Rate for Payer: PHCS Commercial |
$25,491.84
|
| Rate for Payer: United Healthcare All Payer |
$23,367.52
|
|
|
SROM FEM STM 18*13*255 R XLG
|
Facility
|
IP
|
$30,277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,936.01 |
| Max. Negotiated Rate |
$29,065.92 |
| Rate for Payer: Aetna Commercial |
$23,313.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,616.06
|
| Rate for Payer: Cash Price |
$15,138.50
|
| Rate for Payer: Cigna Commercial |
$25,129.91
|
| Rate for Payer: First Health Commercial |
$28,763.15
|
| Rate for Payer: Humana Commercial |
$25,735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,344.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,083.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,643.76
|
| Rate for Payer: Ohio Health Group HMO |
$22,707.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,055.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,936.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,385.87
|
| Rate for Payer: PHCS Commercial |
$29,065.92
|
| Rate for Payer: United Healthcare All Payer |
$26,643.76
|
|
|
SROM FEM STM 18*13*255 R XLG
|
Facility
|
OP
|
$30,277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,936.01 |
| Max. Negotiated Rate |
$29,065.92 |
| Rate for Payer: Aetna Commercial |
$23,313.29
|
| Rate for Payer: Anthem Medicaid |
$10,412.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,616.06
|
| Rate for Payer: Cash Price |
$15,138.50
|
| Rate for Payer: Cigna Commercial |
$25,129.91
|
| Rate for Payer: First Health Commercial |
$28,763.15
|
| Rate for Payer: Humana Commercial |
$25,735.45
|
| Rate for Payer: Humana KY Medicaid |
$10,412.26
|
| Rate for Payer: Kentucky WC Medicaid |
$10,518.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,344.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,083.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,621.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,643.76
|
| Rate for Payer: Ohio Health Group HMO |
$22,707.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,055.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,936.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,385.87
|
| Rate for Payer: PHCS Commercial |
$29,065.92
|
| Rate for Payer: United Healthcare All Payer |
$26,643.76
|
|
|
S-ROM HEAD FEM COCR 22 +0
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 22 +0
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 26 +0
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 26 +0
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 26 +6
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 26 +6
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 28 +0
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
