|
SWANSON CARPAL SCAPHOID #2 R
|
Facility
|
OP
|
$21,228.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.72 |
| Max. Negotiated Rate |
$20,379.50 |
| Rate for Payer: Aetna Commercial |
$16,346.06
|
| Rate for Payer: Anthem Medicaid |
$7,300.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,558.35
|
| Rate for Payer: Cash Price |
$10,614.33
|
| Rate for Payer: Cigna Commercial |
$17,619.78
|
| Rate for Payer: First Health Commercial |
$20,167.22
|
| Rate for Payer: Humana Commercial |
$18,044.35
|
| Rate for Payer: Humana KY Medicaid |
$7,300.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,374.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,407.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,666.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,368.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,447.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,681.21
|
| Rate for Payer: Ohio Health Group HMO |
$15,921.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,580.88
|
| Rate for Payer: PHCS Commercial |
$20,379.50
|
| Rate for Payer: United Healthcare All Payer |
$18,681.21
|
|
|
SWANSON CARPAL SCAPHOID #2 R
|
Facility
|
IP
|
$21,228.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.72 |
| Max. Negotiated Rate |
$20,379.50 |
| Rate for Payer: Aetna Commercial |
$16,346.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,558.35
|
| Rate for Payer: Cash Price |
$10,614.33
|
| Rate for Payer: Cigna Commercial |
$17,619.78
|
| Rate for Payer: First Health Commercial |
$20,167.22
|
| Rate for Payer: Humana Commercial |
$18,044.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,407.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,666.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,368.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,681.21
|
| Rate for Payer: Ohio Health Group HMO |
$15,921.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,580.88
|
| Rate for Payer: PHCS Commercial |
$20,379.50
|
| Rate for Payer: United Healthcare All Payer |
$18,681.21
|
|
|
SWANSON FINGER WIRE .035
|
Facility
|
IP
|
$479.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$460.47 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.13
|
| Rate for Payer: Cash Price |
$239.83
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: First Health Commercial |
$455.68
|
| Rate for Payer: Humana Commercial |
$407.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.10
|
| Rate for Payer: Ohio Health Group HMO |
$359.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.69
|
| Rate for Payer: PHCS Commercial |
$460.47
|
| Rate for Payer: United Healthcare All Payer |
$422.10
|
|
|
SWANSON FINGER WIRE .035
|
Facility
|
OP
|
$479.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$460.47 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Anthem Medicaid |
$164.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.13
|
| Rate for Payer: Cash Price |
$239.83
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: First Health Commercial |
$455.68
|
| Rate for Payer: Humana Commercial |
$407.71
|
| Rate for Payer: Humana KY Medicaid |
$164.96
|
| Rate for Payer: Kentucky WC Medicaid |
$166.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.10
|
| Rate for Payer: Ohio Health Group HMO |
$359.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.69
|
| Rate for Payer: PHCS Commercial |
$460.47
|
| Rate for Payer: United Healthcare All Payer |
$422.10
|
|
|
SWANSON FINGER WIRE .045
|
Facility
|
OP
|
$479.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$460.47 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Anthem Medicaid |
$164.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.13
|
| Rate for Payer: Cash Price |
$239.83
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: First Health Commercial |
$455.68
|
| Rate for Payer: Humana Commercial |
$407.71
|
| Rate for Payer: Humana KY Medicaid |
$164.96
|
| Rate for Payer: Kentucky WC Medicaid |
$166.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.10
|
| Rate for Payer: Ohio Health Group HMO |
$359.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.69
|
| Rate for Payer: PHCS Commercial |
$460.47
|
| Rate for Payer: United Healthcare All Payer |
$422.10
|
|
|
SWANSON FINGER WIRE .045
|
Facility
|
IP
|
$479.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$460.47 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.13
|
| Rate for Payer: Cash Price |
$239.83
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: First Health Commercial |
$455.68
|
| Rate for Payer: Humana Commercial |
$407.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.10
|
| Rate for Payer: Ohio Health Group HMO |
$359.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.69
|
| Rate for Payer: PHCS Commercial |
$460.47
|
| Rate for Payer: United Healthcare All Payer |
$422.10
|
|
|
SWANSON FINGER WIRE .062
|
Facility
|
OP
|
$479.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$460.47 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Anthem Medicaid |
$164.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.13
|
| Rate for Payer: Cash Price |
$239.83
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: First Health Commercial |
$455.68
|
| Rate for Payer: Humana Commercial |
$407.71
|
| Rate for Payer: Humana KY Medicaid |
$164.96
|
| Rate for Payer: Kentucky WC Medicaid |
$166.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.10
|
| Rate for Payer: Ohio Health Group HMO |
$359.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.69
|
| Rate for Payer: PHCS Commercial |
$460.47
|
| Rate for Payer: United Healthcare All Payer |
$422.10
|
|
|
SWANSON FINGER WIRE .062
|
Facility
|
IP
|
$479.66
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$460.47 |
| Rate for Payer: Aetna Commercial |
$369.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.13
|
| Rate for Payer: Cash Price |
$239.83
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: First Health Commercial |
$455.68
|
| Rate for Payer: Humana Commercial |
$407.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$353.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.10
|
| Rate for Payer: Ohio Health Group HMO |
$359.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.69
|
| Rate for Payer: PHCS Commercial |
$460.47
|
| Rate for Payer: United Healthcare All Payer |
$422.10
|
|
|
SWANSON MP JOINT IMP KIT W/SZR
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
SWANSON MP JOINT IMP KIT W/SZR
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
SWANSON PIP IMP SZ 0
|
Facility
|
OP
|
$6,825.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.37 |
| Max. Negotiated Rate |
$6,552.91 |
| Rate for Payer: Aetna Commercial |
$5,255.98
|
| Rate for Payer: Anthem Medicaid |
$2,347.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,324.24
|
| Rate for Payer: Cash Price |
$3,412.98
|
| Rate for Payer: Cigna Commercial |
$5,665.54
|
| Rate for Payer: First Health Commercial |
$6,484.65
|
| Rate for Payer: Humana Commercial |
$5,802.06
|
| Rate for Payer: Humana KY Medicaid |
$2,347.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,371.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,597.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,037.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,047.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,394.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,006.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.04
|
| Rate for Payer: PHCS Commercial |
$6,552.91
|
| Rate for Payer: United Healthcare All Payer |
$6,006.84
|
|
|
SWANSON PIP IMP SZ 0
|
Facility
|
IP
|
$6,825.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.37 |
| Max. Negotiated Rate |
$6,552.91 |
| Rate for Payer: Aetna Commercial |
$5,255.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,324.24
|
| Rate for Payer: Cash Price |
$3,412.98
|
| Rate for Payer: Cigna Commercial |
$5,665.54
|
| Rate for Payer: First Health Commercial |
$6,484.65
|
| Rate for Payer: Humana Commercial |
$5,802.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,597.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,037.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,047.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,006.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.04
|
| Rate for Payer: PHCS Commercial |
$6,552.91
|
| Rate for Payer: United Healthcare All Payer |
$6,006.84
|
|
|
SWANSON PIP IMP SZ 00
|
Facility
|
OP
|
$7,194.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.30 |
| Max. Negotiated Rate |
$6,906.82 |
| Rate for Payer: Aetna Commercial |
$5,539.84
|
| Rate for Payer: Anthem Medicaid |
$2,474.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,611.79
|
| Rate for Payer: Cash Price |
$3,597.30
|
| Rate for Payer: Cigna Commercial |
$5,971.52
|
| Rate for Payer: First Health Commercial |
$6,834.87
|
| Rate for Payer: Humana Commercial |
$6,115.41
|
| Rate for Payer: Humana KY Medicaid |
$2,474.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,499.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,899.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,309.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,523.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,331.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,395.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,230.33
|
| Rate for Payer: PHCS Commercial |
$6,906.82
|
| Rate for Payer: United Healthcare All Payer |
$6,331.25
|
|
|
SWANSON PIP IMP SZ 00
|
Facility
|
IP
|
$7,194.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.30 |
| Max. Negotiated Rate |
$6,906.82 |
| Rate for Payer: Aetna Commercial |
$5,539.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,611.79
|
| Rate for Payer: Cash Price |
$3,597.30
|
| Rate for Payer: Cigna Commercial |
$5,971.52
|
| Rate for Payer: First Health Commercial |
$6,834.87
|
| Rate for Payer: Humana Commercial |
$6,115.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,899.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,309.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,331.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,395.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,230.33
|
| Rate for Payer: PHCS Commercial |
$6,906.82
|
| Rate for Payer: United Healthcare All Payer |
$6,331.25
|
|
|
SWANSON PIP IMP SZ 1
|
Facility
|
OP
|
$6,825.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.37 |
| Max. Negotiated Rate |
$6,552.91 |
| Rate for Payer: Aetna Commercial |
$5,255.98
|
| Rate for Payer: Anthem Medicaid |
$2,347.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,324.24
|
| Rate for Payer: Cash Price |
$3,412.98
|
| Rate for Payer: Cigna Commercial |
$5,665.54
|
| Rate for Payer: First Health Commercial |
$6,484.65
|
| Rate for Payer: Humana Commercial |
$5,802.06
|
| Rate for Payer: Humana KY Medicaid |
$2,347.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,371.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,597.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,037.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,047.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,394.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,006.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.04
|
| Rate for Payer: PHCS Commercial |
$6,552.91
|
| Rate for Payer: United Healthcare All Payer |
$6,006.84
|
|
|
SWANSON PIP IMP SZ 1
|
Facility
|
IP
|
$6,825.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.37 |
| Max. Negotiated Rate |
$6,552.91 |
| Rate for Payer: Aetna Commercial |
$5,255.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,324.24
|
| Rate for Payer: Cash Price |
$3,412.98
|
| Rate for Payer: Cigna Commercial |
$5,665.54
|
| Rate for Payer: First Health Commercial |
$6,484.65
|
| Rate for Payer: Humana Commercial |
$5,802.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,597.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,037.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,047.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,006.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,365.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$887.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,116.04
|
| Rate for Payer: PHCS Commercial |
$6,552.91
|
| Rate for Payer: United Healthcare All Payer |
$6,006.84
|
|
|
SWANSON PIP IMP SZ 2
|
Facility
|
OP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem Medicaid |
$1,650.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Humana KY Medicaid |
$1,650.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 2
|
Facility
|
IP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 3 W/GROMMET
|
Facility
|
IP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 3 W/GROMMET
|
Facility
|
OP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem Medicaid |
$1,650.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Humana KY Medicaid |
$1,650.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 4 W/GROMMET
|
Facility
|
IP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 4 W/GROMMET
|
Facility
|
OP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem Medicaid |
$1,650.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Humana KY Medicaid |
$1,650.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 5 W/GROMMET
|
Facility
|
IP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ 5 W/GROMMET
|
Facility
|
OP
|
$4,800.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.06 |
| Max. Negotiated Rate |
$4,608.48 |
| Rate for Payer: Aetna Commercial |
$3,696.38
|
| Rate for Payer: Anthem Medicaid |
$1,650.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.39
|
| Rate for Payer: Cash Price |
$2,400.25
|
| Rate for Payer: Cigna Commercial |
$3,984.42
|
| Rate for Payer: First Health Commercial |
$4,560.48
|
| Rate for Payer: Humana Commercial |
$4,080.42
|
| Rate for Payer: Humana KY Medicaid |
$1,650.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,667.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,936.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,542.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,224.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.16
|
| Rate for Payer: PHCS Commercial |
$4,608.48
|
| Rate for Payer: United Healthcare All Payer |
$4,224.44
|
|
|
SWANSON PIP IMP SZ6 W/GROMMETS
|
Facility
|
IP
|
$7,691.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.83 |
| Max. Negotiated Rate |
$7,383.36 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,998.98
|
| Rate for Payer: Cash Price |
$3,845.50
|
| Rate for Payer: Cigna Commercial |
$6,383.53
|
| Rate for Payer: First Health Commercial |
$7,306.45
|
| Rate for Payer: Humana Commercial |
$6,537.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,306.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,675.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,768.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,768.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,384.21
|
| Rate for Payer: PHCS Commercial |
$7,383.36
|
| Rate for Payer: United Healthcare All Payer |
$6,768.08
|
|
