|
SROM KNEE FEM SLEEVE POR 46MM
|
Facility
|
OP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem Medicaid |
$3,085.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Humana KY Medicaid |
$3,085.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,116.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,147.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM KNEE FEM SLEEVE POR 46MM
|
Facility
|
IP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM MARATHON LINER L 28 10
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 28 10
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 28 NEU
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 28 NEU
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 32 10
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 32 10
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 32 NEU
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER L 32 NEU
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER M 28 10
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER M 28 10
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER M 28 NEU
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MARATHON LINER M 28 NEU
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MAR LNR L 28MM +3MM 10
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MAR LNR L 28MM +3MM 10
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MAR LNR L 32MM +3MM 10
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MAR LNR L 32MM +3MM 10
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MAR LNR M 28MM +3MM 10
|
Facility
|
OP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem Medicaid |
$2,844.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Humana KY Medicaid |
$2,844.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
SROM MAR LNR M 28MM +3MM 10
|
Facility
|
IP
|
$8,271.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.28 |
| Max. Negotiated Rate |
$7,940.50 |
| Rate for Payer: Aetna Commercial |
$6,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,451.65
|
| Rate for Payer: Cash Price |
$4,135.68
|
| Rate for Payer: Cigna Commercial |
$6,865.22
|
| Rate for Payer: First Health Commercial |
$7,857.78
|
| Rate for Payer: Humana Commercial |
$7,030.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,782.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,278.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,203.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.12
|
| Rate for Payer: PHCS Commercial |
$7,940.50
|
| Rate for Payer: United Healthcare All Payer |
$7,278.79
|
|
|
S-ROM M METAL FEM HEAD 36+9
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
S-ROM M METAL FEM HEAD 36+9
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
SROM NRH DIST AUG XS/S/MED 10M
|
Facility
|
IP
|
$7,388.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.52 |
| Max. Negotiated Rate |
$7,093.06 |
| Rate for Payer: Aetna Commercial |
$5,689.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.11
|
| Rate for Payer: Cash Price |
$3,694.30
|
| Rate for Payer: Cigna Commercial |
$6,132.54
|
| Rate for Payer: First Health Commercial |
$7,019.17
|
| Rate for Payer: Humana Commercial |
$6,280.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,058.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,452.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,501.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.47
|
| Rate for Payer: PHCS Commercial |
$7,093.06
|
| Rate for Payer: United Healthcare All Payer |
$6,501.97
|
|
|
SROM NRH DIST AUG XS/S/MED 10M
|
Facility
|
OP
|
$7,388.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.52 |
| Max. Negotiated Rate |
$7,093.06 |
| Rate for Payer: Aetna Commercial |
$5,689.22
|
| Rate for Payer: Anthem Medicaid |
$2,540.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.11
|
| Rate for Payer: Cash Price |
$3,694.30
|
| Rate for Payer: Cigna Commercial |
$6,132.54
|
| Rate for Payer: First Health Commercial |
$7,019.17
|
| Rate for Payer: Humana Commercial |
$6,280.31
|
| Rate for Payer: Humana KY Medicaid |
$2,540.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,058.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,452.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,591.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,501.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.47
|
| Rate for Payer: PHCS Commercial |
$7,093.06
|
| Rate for Payer: United Healthcare All Payer |
$6,501.97
|
|
|
SROM NRH DIST AUG XS/S/MED 5MM
|
Facility
|
OP
|
$8,411.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.54 |
| Max. Negotiated Rate |
$8,075.40 |
| Rate for Payer: Aetna Commercial |
$6,477.15
|
| Rate for Payer: Anthem Medicaid |
$2,892.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,561.27
|
| Rate for Payer: Cash Price |
$4,205.94
|
| Rate for Payer: Cigna Commercial |
$6,981.86
|
| Rate for Payer: First Health Commercial |
$7,991.29
|
| Rate for Payer: Humana Commercial |
$7,150.10
|
| Rate for Payer: Humana KY Medicaid |
$2,892.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,922.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,897.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,207.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,523.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,950.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,402.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,308.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,682.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,607.68
|
| Rate for Payer: PHCS Commercial |
$8,075.40
|
| Rate for Payer: United Healthcare All Payer |
$7,402.45
|
|
