|
TMJ WITH ANESTH
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.76 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.77
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TMJ WITH ANESTH
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$664.76 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.77
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TMJ WITH ANESTH
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$579.90 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.77
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TMJ WITH ANESTH
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.90 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.77
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TM KEEL GLEN 40MM W/46MM SRFC
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 40MM W/46MM SRFC
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 46MM
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 46MM
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 46MM W/40MM SRFC
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 46MM W/40MM SRFC
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 46MM W/52MM SRFC
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 46MM W/52MM SRFC
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 52MM
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 52MM
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 52MM W/46MM SRFC
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 52MM W/46MM SRFC
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 52MM W/56MM SRFC
|
Facility
|
OP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem Medicaid |
$3,439.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Humana KY Medicaid |
$3,439.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,474.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,508.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLEN 52MM W/56MM SRFC
|
Facility
|
IP
|
$10,000.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,000.21 |
| Max. Negotiated Rate |
$9,600.67 |
| Rate for Payer: Aetna Commercial |
$7,700.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,800.55
|
| Rate for Payer: Cash Price |
$5,000.35
|
| Rate for Payer: Cigna Commercial |
$8,300.58
|
| Rate for Payer: First Health Commercial |
$9,500.67
|
| Rate for Payer: Humana Commercial |
$8,500.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,200.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,380.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,000.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,800.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,500.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,000.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,700.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,900.48
|
| Rate for Payer: PHCS Commercial |
$9,600.67
|
| Rate for Payer: United Healthcare All Payer |
$8,800.62
|
|
|
TM KEEL GLENOD 40MM W/46M SURF
|
Facility
|
IP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
|
TM KEEL GLENOD 40MM W/46M SURF
|
Facility
|
OP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem Medicaid |
$3,196.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Humana KY Medicaid |
$3,196.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,260.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
|
TM KEEL GLENOD 46MM W/40M SURF
|
Facility
|
OP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem Medicaid |
$3,196.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Humana KY Medicaid |
$3,196.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,260.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
|
TM KEEL GLENOD 46MM W/40M SURF
|
Facility
|
IP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
|
TM KEEL GLENOD 46MM W/52M SURF
|
Facility
|
OP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem Medicaid |
$3,196.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Humana KY Medicaid |
$3,196.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,260.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
|
TM KEEL GLENOD 46MM W/52M SURF
|
Facility
|
IP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
|
TM KEEL GLENOD 52MM W/46MM SRF
|
Facility
|
IP
|
$9,295.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.66 |
| Max. Negotiated Rate |
$8,923.70 |
| Rate for Payer: Aetna Commercial |
$7,157.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,250.51
|
| Rate for Payer: Cash Price |
$4,647.76
|
| Rate for Payer: Cigna Commercial |
$7,715.28
|
| Rate for Payer: First Health Commercial |
$8,830.74
|
| Rate for Payer: Humana Commercial |
$7,901.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,622.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,860.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,180.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,971.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,436.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,087.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,413.91
|
| Rate for Payer: PHCS Commercial |
$8,923.70
|
| Rate for Payer: United Healthcare All Payer |
$8,180.06
|
|
