|
TM REV 40MM 65 RTNT POLY LNR+0
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REV 40MM 65 RTNT POLY LNR+0
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REV 40MM 65 RTNT POLY LNR+3
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REV 40MM 65 RTNT POLY LNR+3
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REV 40MM 65 RTNT POLY LNR+6
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
TM REV 40MM 65 RTNT POLY LNR+6
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
TM REVERSE 36MM GLENOSPHERE
|
Facility
|
OP
|
$9,102.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.84 |
| Max. Negotiated Rate |
$8,738.69 |
| Rate for Payer: Aetna Commercial |
$7,009.16
|
| Rate for Payer: Anthem Medicaid |
$3,130.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,100.18
|
| Rate for Payer: Cash Price |
$4,551.40
|
| Rate for Payer: Cigna Commercial |
$7,555.32
|
| Rate for Payer: First Health Commercial |
$8,647.66
|
| Rate for Payer: Humana Commercial |
$7,737.38
|
| Rate for Payer: Humana KY Medicaid |
$3,130.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,162.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,464.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,717.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,193.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,010.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,282.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,919.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,280.93
|
| Rate for Payer: PHCS Commercial |
$8,738.69
|
| Rate for Payer: United Healthcare All Payer |
$8,010.46
|
|
|
TM REVERSE 36MM GLENOSPHERE
|
Facility
|
IP
|
$9,102.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.84 |
| Max. Negotiated Rate |
$8,738.69 |
| Rate for Payer: Aetna Commercial |
$7,009.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,100.18
|
| Rate for Payer: Cash Price |
$4,551.40
|
| Rate for Payer: Cigna Commercial |
$7,555.32
|
| Rate for Payer: First Health Commercial |
$8,647.66
|
| Rate for Payer: Humana Commercial |
$7,737.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,464.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,717.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,010.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,282.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,919.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,280.93
|
| Rate for Payer: PHCS Commercial |
$8,738.69
|
| Rate for Payer: United Healthcare All Payer |
$8,010.46
|
|
|
TM REVERSE 36MM POLY LINER +0
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 36MM POLY LINER +0
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 36MM POLY LINER +3
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 36MM POLY LINER +3
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 36MM POLY LINER +6
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 36MM POLY LINER +6
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 36MM POLY LNR +0
|
Facility
|
IP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 36MM POLY LNR +0
|
Facility
|
OP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem Medicaid |
$2,883.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Humana KY Medicaid |
$2,883.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 36MM POLY LNR +3
|
Facility
|
OP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem Medicaid |
$2,883.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Humana KY Medicaid |
$2,883.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 36MM POLY LNR +3
|
Facility
|
IP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 36MM POLY LNR +6
|
Facility
|
IP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 36MM POLY LNR +6
|
Facility
|
OP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem Medicaid |
$2,883.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Humana KY Medicaid |
$2,883.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 40MM GLENOSPHERE
|
Facility
|
IP
|
$9,102.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.84 |
| Max. Negotiated Rate |
$8,738.69 |
| Rate for Payer: Aetna Commercial |
$7,009.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,100.18
|
| Rate for Payer: Cash Price |
$4,551.40
|
| Rate for Payer: Cigna Commercial |
$7,555.32
|
| Rate for Payer: First Health Commercial |
$8,647.66
|
| Rate for Payer: Humana Commercial |
$7,737.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,464.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,717.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,010.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,282.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,919.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,280.93
|
| Rate for Payer: PHCS Commercial |
$8,738.69
|
| Rate for Payer: United Healthcare All Payer |
$8,010.46
|
|
|
TM REVERSE 40MM GLENOSPHERE
|
Facility
|
OP
|
$9,102.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.84 |
| Max. Negotiated Rate |
$8,738.69 |
| Rate for Payer: Aetna Commercial |
$7,009.16
|
| Rate for Payer: Anthem Medicaid |
$3,130.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,100.18
|
| Rate for Payer: Cash Price |
$4,551.40
|
| Rate for Payer: Cigna Commercial |
$7,555.32
|
| Rate for Payer: First Health Commercial |
$8,647.66
|
| Rate for Payer: Humana Commercial |
$7,737.38
|
| Rate for Payer: Humana KY Medicaid |
$3,130.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,162.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,464.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,717.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,193.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,010.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,282.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,919.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,280.93
|
| Rate for Payer: PHCS Commercial |
$8,738.69
|
| Rate for Payer: United Healthcare All Payer |
$8,010.46
|
|
|
TM REVERSE 40MM POLY LINER +0
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 40MM POLY LINER +0
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 40MM POLY LINER +3
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
