|
SPACER ELEOS TIBIAL POLY 16MM
|
Facility
|
OP
|
$13,431.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.31 |
| Max. Negotiated Rate |
$12,893.78 |
| Rate for Payer: Aetna Commercial |
$10,341.89
|
| Rate for Payer: Anthem Medicaid |
$4,618.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,476.20
|
| Rate for Payer: Cash Price |
$6,715.51
|
| Rate for Payer: Cigna Commercial |
$11,147.75
|
| Rate for Payer: First Health Commercial |
$12,759.47
|
| Rate for Payer: Humana Commercial |
$11,416.37
|
| Rate for Payer: Humana KY Medicaid |
$4,618.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,665.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,013.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,912.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,029.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,711.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,819.30
|
| Rate for Payer: Ohio Health Group HMO |
$10,073.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,744.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,684.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,267.40
|
| Rate for Payer: PHCS Commercial |
$12,893.78
|
| Rate for Payer: United Healthcare All Payer |
$11,819.30
|
|
|
SPACER ELEOS TIBIAL POLY 16MM
|
Facility
|
IP
|
$13,431.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.31 |
| Max. Negotiated Rate |
$12,893.78 |
| Rate for Payer: Aetna Commercial |
$10,341.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,476.20
|
| Rate for Payer: Cash Price |
$6,715.51
|
| Rate for Payer: Cigna Commercial |
$11,147.75
|
| Rate for Payer: First Health Commercial |
$12,759.47
|
| Rate for Payer: Humana Commercial |
$11,416.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,013.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,912.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,029.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,819.30
|
| Rate for Payer: Ohio Health Group HMO |
$10,073.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,744.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,684.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,267.40
|
| Rate for Payer: PHCS Commercial |
$12,893.78
|
| Rate for Payer: United Healthcare All Payer |
$11,819.30
|
|
|
SPACER ELEOS TIBIAL POLY 8MM
|
Facility
|
OP
|
$13,431.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.31 |
| Max. Negotiated Rate |
$12,893.78 |
| Rate for Payer: Aetna Commercial |
$10,341.89
|
| Rate for Payer: Anthem Medicaid |
$4,618.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,476.20
|
| Rate for Payer: Cash Price |
$6,715.51
|
| Rate for Payer: Cigna Commercial |
$11,147.75
|
| Rate for Payer: First Health Commercial |
$12,759.47
|
| Rate for Payer: Humana Commercial |
$11,416.37
|
| Rate for Payer: Humana KY Medicaid |
$4,618.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,665.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,013.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,912.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,029.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,711.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,819.30
|
| Rate for Payer: Ohio Health Group HMO |
$10,073.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,744.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,684.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,267.40
|
| Rate for Payer: PHCS Commercial |
$12,893.78
|
| Rate for Payer: United Healthcare All Payer |
$11,819.30
|
|
|
SPACER ELEOS TIBIAL POLY 8MM
|
Facility
|
IP
|
$13,431.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,029.31 |
| Max. Negotiated Rate |
$12,893.78 |
| Rate for Payer: Aetna Commercial |
$10,341.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,476.20
|
| Rate for Payer: Cash Price |
$6,715.51
|
| Rate for Payer: Cigna Commercial |
$11,147.75
|
| Rate for Payer: First Health Commercial |
$12,759.47
|
| Rate for Payer: Humana Commercial |
$11,416.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,013.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,912.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,029.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,819.30
|
| Rate for Payer: Ohio Health Group HMO |
$10,073.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,744.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,684.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,267.40
|
| Rate for Payer: PHCS Commercial |
$12,893.78
|
| Rate for Payer: United Healthcare All Payer |
$11,819.30
|
|
|
SPACER MOD CATHCART TPR 12/14
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
SPACER MOD CATHCART TPR 12/14
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
SPACER NCB 1MM
|
Facility
|
OP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem Medicaid |
$645.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Humana KY Medicaid |
$645.71
|
| Rate for Payer: Kentucky WC Medicaid |
$652.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
SPACER NCB 1MM
|
Facility
|
IP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
SPACER NCB 2MM
|
Facility
|
IP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
SPACER NCB 2MM
|
Facility
|
OP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem Medicaid |
$645.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Humana KY Medicaid |
$645.71
|
| Rate for Payer: Kentucky WC Medicaid |
$652.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
SPACER NCB 3MM
|
Facility
|
IP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
SPACER NCB 3MM
|
Facility
|
OP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem Medicaid |
$645.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Humana KY Medicaid |
$645.71
|
| Rate for Payer: Kentucky WC Medicaid |
$652.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
SPACR MOD CATHCRT TPR 12/14 -3
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
SPACR MOD CATHCRT TPR 12/14 -3
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
SPATIAL FRAME IDENT BAND KIT
|
Facility
|
IP
|
$2,965.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$889.58 |
| Max. Negotiated Rate |
$2,846.64 |
| Rate for Payer: Aetna Commercial |
$2,283.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,312.89
|
| Rate for Payer: Cash Price |
$1,482.62
|
| Rate for Payer: Cigna Commercial |
$2,461.16
|
| Rate for Payer: First Health Commercial |
$2,816.99
|
| Rate for Payer: Humana Commercial |
$2,520.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,188.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$889.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,609.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,223.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,372.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,579.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.02
|
| Rate for Payer: PHCS Commercial |
$2,846.64
|
| Rate for Payer: United Healthcare All Payer |
$2,609.42
|
|
|
SPATIAL FRAME IDENT BAND KIT
|
Facility
|
OP
|
$2,965.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$889.58 |
| Max. Negotiated Rate |
$2,846.64 |
| Rate for Payer: Aetna Commercial |
$2,283.24
|
| Rate for Payer: Anthem Medicaid |
$1,019.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,312.89
|
| Rate for Payer: Cash Price |
$1,482.62
|
| Rate for Payer: Cigna Commercial |
$2,461.16
|
| Rate for Payer: First Health Commercial |
$2,816.99
|
| Rate for Payer: Humana Commercial |
$2,520.46
|
| Rate for Payer: Humana KY Medicaid |
$1,019.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,030.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,188.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$889.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,040.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,609.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,223.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,372.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,579.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.02
|
| Rate for Payer: PHCS Commercial |
$2,846.64
|
| Rate for Payer: United Healthcare All Payer |
$2,609.42
|
|
|
SPATIAL FRAME SHOULDER BOLT
|
Facility
|
IP
|
$1,108.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.42 |
| Max. Negotiated Rate |
$1,063.73 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.28
|
| Rate for Payer: Cash Price |
$554.02
|
| Rate for Payer: Cigna Commercial |
$919.68
|
| Rate for Payer: First Health Commercial |
$1,052.65
|
| Rate for Payer: Humana Commercial |
$941.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.08
|
| Rate for Payer: Ohio Health Group HMO |
$831.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.55
|
| Rate for Payer: PHCS Commercial |
$1,063.73
|
| Rate for Payer: United Healthcare All Payer |
$975.08
|
|
|
SPATIAL FRAME SHOULDER BOLT
|
Facility
|
OP
|
$1,108.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.42 |
| Max. Negotiated Rate |
$1,063.73 |
| Rate for Payer: Aetna Commercial |
$853.20
|
| Rate for Payer: Anthem Medicaid |
$381.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.28
|
| Rate for Payer: Cash Price |
$554.02
|
| Rate for Payer: Cigna Commercial |
$919.68
|
| Rate for Payer: First Health Commercial |
$1,052.65
|
| Rate for Payer: Humana Commercial |
$941.84
|
| Rate for Payer: Humana KY Medicaid |
$381.06
|
| Rate for Payer: Kentucky WC Medicaid |
$384.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.08
|
| Rate for Payer: Ohio Health Group HMO |
$831.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.55
|
| Rate for Payer: PHCS Commercial |
$1,063.73
|
| Rate for Payer: United Healthcare All Payer |
$975.08
|
|
|
SP COGNITION RETRAINING
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SP COGNITION RETRAINING
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 92507
|
| Hospital Charge Code |
44000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
S P CONSULT PREPARED AT SOMC
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30001518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$397.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.33
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
S P CONSULT PREPARED AT SOMC
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30001518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.97
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$397.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.33
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
S P CONSULT PREP AT SOMC
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30002035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$436.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.30
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$470.61
|
| Rate for Payer: First Health Commercial |
$538.65
|
| Rate for Payer: Humana Commercial |
$481.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.96
|
| Rate for Payer: Ohio Health Group HMO |
$425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.23
|
| Rate for Payer: PHCS Commercial |
$544.32
|
| Rate for Payer: United Healthcare All Payer |
$498.96
|
|
|
S P CONSULT PREP AT SOMC
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30002035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$436.59
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$470.61
|
| Rate for Payer: First Health Commercial |
$538.65
|
| Rate for Payer: Humana Commercial |
$481.95
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.96
|
| Rate for Payer: Ohio Health Group HMO |
$425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.23
|
| Rate for Payer: PHCS Commercial |
$544.32
|
| Rate for Payer: United Healthcare All Payer |
$498.96
|
|
|
S P CONSULT PREP AT SOMC
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30002035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Ambetter Exchange |
$107.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.52
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$89.15
|
| Rate for Payer: Healthspan PPO |
$207.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.93
|
| Rate for Payer: Multiplan PHCS |
$340.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.31
|
| Rate for Payer: UHCCP Medicaid |
$198.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.93
|
|
