|
SROM KNEE FEM SLEEVE POR 40MM
|
Facility
|
OP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem Medicaid |
$3,154.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Humana KY Medicaid |
$3,154.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,186.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,217.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM KNEE FEM SLEEVE POR 46MM
|
Facility
|
OP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem Medicaid |
$3,154.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Humana KY Medicaid |
$3,154.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,186.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,217.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM KNEE FEM SLEEVE POR 46MM
|
Facility
|
IP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM MARATHON LINER L 28 10
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 28 10
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 28 NEU
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 28 NEU
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 32 10
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 32 10
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 32 NEU
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER L 32 NEU
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER M 28 10
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER M 28 10
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER M 28 NEU
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MARATHON LINER M 28 NEU
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MAR LNR L 28MM +3MM 10
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MAR LNR L 28MM +3MM 10
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MAR LNR L 32MM +3MM 10
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MAR LNR L 32MM +3MM 10
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MAR LNR M 28MM +3MM 10
|
Facility
|
OP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem Medicaid |
$2,913.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Humana KY Medicaid |
$2,913.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,942.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,971.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
SROM MAR LNR M 28MM +3MM 10
|
Facility
|
IP
|
$8,471.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.41 |
| Max. Negotiated Rate |
$8,132.50 |
| Rate for Payer: Aetna Commercial |
$6,522.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,607.65
|
| Rate for Payer: Cash Price |
$4,235.68
|
| Rate for Payer: Cigna Commercial |
$7,031.22
|
| Rate for Payer: First Health Commercial |
$8,047.78
|
| Rate for Payer: Humana Commercial |
$7,200.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,946.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,251.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,454.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,353.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.23
|
| Rate for Payer: PHCS Commercial |
$8,132.50
|
| Rate for Payer: United Healthcare All Payer |
$7,454.79
|
|
|
S-ROM M METAL FEM HEAD 36+9
|
Facility
|
IP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
S-ROM M METAL FEM HEAD 36+9
|
Facility
|
OP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem Medicaid |
$2,952.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Humana KY Medicaid |
$2,952.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
SROM NRH DIST AUG XS/S/MED 10M
|
Facility
|
IP
|
$7,588.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.58 |
| Max. Negotiated Rate |
$7,285.06 |
| Rate for Payer: Aetna Commercial |
$5,843.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.11
|
| Rate for Payer: Cash Price |
$3,794.30
|
| Rate for Payer: Cigna Commercial |
$6,298.54
|
| Rate for Payer: First Health Commercial |
$7,209.17
|
| Rate for Payer: Humana Commercial |
$6,450.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,222.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,600.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,677.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,691.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,070.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.13
|
| Rate for Payer: PHCS Commercial |
$7,285.06
|
| Rate for Payer: United Healthcare All Payer |
$6,677.97
|
|
|
SROM NRH DIST AUG XS/S/MED 10M
|
Facility
|
OP
|
$7,588.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.58 |
| Max. Negotiated Rate |
$7,285.06 |
| Rate for Payer: Aetna Commercial |
$5,843.22
|
| Rate for Payer: Anthem Medicaid |
$2,609.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.11
|
| Rate for Payer: Cash Price |
$3,794.30
|
| Rate for Payer: Cigna Commercial |
$6,298.54
|
| Rate for Payer: First Health Commercial |
$7,209.17
|
| Rate for Payer: Humana Commercial |
$6,450.31
|
| Rate for Payer: Humana KY Medicaid |
$2,609.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,636.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,222.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,600.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,677.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,691.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,070.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.13
|
| Rate for Payer: PHCS Commercial |
$7,285.06
|
| Rate for Payer: United Healthcare All Payer |
$6,677.97
|
|
