|
TM FEM DIAPHYSEAL CONE 30 MEDR
|
Facility
|
IP
|
$21,893.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.10 |
| Max. Negotiated Rate |
$21,017.34 |
| Rate for Payer: Aetna Commercial |
$16,857.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,076.59
|
| Rate for Payer: Cash Price |
$10,946.53
|
| Rate for Payer: Cigna Commercial |
$18,171.24
|
| Rate for Payer: First Health Commercial |
$20,798.41
|
| Rate for Payer: Humana Commercial |
$18,609.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,952.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,265.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,419.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,786.85
|
| Rate for Payer: PHCS Commercial |
$21,017.34
|
| Rate for Payer: United Healthcare All Payer |
$19,265.89
|
|
|
TM FEM DIAPHYSEAL CONE 30 SM L
|
Facility
|
IP
|
$21,893.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.10 |
| Max. Negotiated Rate |
$21,017.34 |
| Rate for Payer: Aetna Commercial |
$16,857.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,076.59
|
| Rate for Payer: Cash Price |
$10,946.53
|
| Rate for Payer: Cigna Commercial |
$18,171.24
|
| Rate for Payer: First Health Commercial |
$20,798.41
|
| Rate for Payer: Humana Commercial |
$18,609.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,952.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,265.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,419.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,786.85
|
| Rate for Payer: PHCS Commercial |
$21,017.34
|
| Rate for Payer: United Healthcare All Payer |
$19,265.89
|
|
|
TM FEM DIAPHYSEAL CONE 30 SM L
|
Facility
|
OP
|
$21,893.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.10 |
| Max. Negotiated Rate |
$21,017.34 |
| Rate for Payer: Aetna Commercial |
$16,857.66
|
| Rate for Payer: Anthem Medicaid |
$7,529.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,076.59
|
| Rate for Payer: Cash Price |
$10,946.53
|
| Rate for Payer: Cigna Commercial |
$18,171.24
|
| Rate for Payer: First Health Commercial |
$20,798.41
|
| Rate for Payer: Humana Commercial |
$18,609.10
|
| Rate for Payer: Humana KY Medicaid |
$7,529.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,952.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,265.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,419.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,786.85
|
| Rate for Payer: PHCS Commercial |
$21,017.34
|
| Rate for Payer: United Healthcare All Payer |
$19,265.89
|
|
|
TM FEM DIAPHYSEAL CONE 30 SM R
|
Facility
|
OP
|
$21,893.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.10 |
| Max. Negotiated Rate |
$21,017.34 |
| Rate for Payer: Aetna Commercial |
$16,857.66
|
| Rate for Payer: Anthem Medicaid |
$7,529.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,076.59
|
| Rate for Payer: Cash Price |
$10,946.53
|
| Rate for Payer: Cigna Commercial |
$18,171.24
|
| Rate for Payer: First Health Commercial |
$20,798.41
|
| Rate for Payer: Humana Commercial |
$18,609.10
|
| Rate for Payer: Humana KY Medicaid |
$7,529.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,952.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,680.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,265.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,419.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,786.85
|
| Rate for Payer: PHCS Commercial |
$21,017.34
|
| Rate for Payer: United Healthcare All Payer |
$19,265.89
|
|
|
TM FEM DIAPHYSEAL CONE 30 SM R
|
Facility
|
IP
|
$21,893.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.10 |
| Max. Negotiated Rate |
$21,017.34 |
| Rate for Payer: Aetna Commercial |
$16,857.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,076.59
|
| Rate for Payer: Cash Price |
$10,946.53
|
| Rate for Payer: Cigna Commercial |
$18,171.24
|
| Rate for Payer: First Health Commercial |
$20,798.41
|
| Rate for Payer: Humana Commercial |
$18,609.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,952.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,157.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,567.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,265.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,419.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,378.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,846.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,786.85
|
| Rate for Payer: PHCS Commercial |
$21,017.34
|
| Rate for Payer: United Healthcare All Payer |
$19,265.89
|
|
|
TM FEM METAPHYSEAL CONE 35 LGL
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 LGL
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 LGR
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 LGR
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 SML
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 SML
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 SMR
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METAPHYSEAL CONE 35 SMR
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METPHYSL CONE 35 MED L
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METPHYSL CONE 35 MED L
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METPHYSL CONE 35 MED R
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM FEM METPHYSL CONE 35 MED R
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TM GLENOD 40MM * 46MM ART SURF
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 40MM * 46MM ART SURF
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 46MM * 40MM ART SURF
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 46MM * 40MM ART SURF
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 46MM * 52MM ART SURF
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 46MM * 52MM ART SURF
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 52MM * 46MM ART SURF
|
Facility
|
IP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
|
TM GLENOD 52MM * 46MM ART SURF
|
Facility
|
OP
|
$11,362.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.08 |
| Max. Negotiated Rate |
$10,907.64 |
| Rate for Payer: Aetna Commercial |
$8,748.83
|
| Rate for Payer: Anthem Medicaid |
$3,907.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,862.45
|
| Rate for Payer: Cash Price |
$5,681.06
|
| Rate for Payer: Cigna Commercial |
$9,430.56
|
| Rate for Payer: First Health Commercial |
$10,794.01
|
| Rate for Payer: Humana Commercial |
$9,657.80
|
| Rate for Payer: Humana KY Medicaid |
$3,907.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,947.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,385.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,998.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,521.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.26
|
| Rate for Payer: PHCS Commercial |
$10,907.64
|
| Rate for Payer: United Healthcare All Payer |
$9,998.67
|
|
