|
BI-METRIC FEMORAL COMP 16*160
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 16*160
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 17*165
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 17*165
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 18*170
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 18*170
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 19*175
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 19*175
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 20*180
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 20*180
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 21*185
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 21*185
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 8*120
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 8*120
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BINOCULAR MICROSCOPY
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 92504
|
| Hospital Charge Code |
47000048
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
BINOCULAR MICROSCOPY
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 92504
|
| Hospital Charge Code |
47000048
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
BINOCULAR MICROSCOPY(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 92504
|
| Hospital Charge Code |
470P0048
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Ambetter Exchange |
$8.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$4.09
|
| Rate for Payer: Anthem Medicaid |
$12.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.57
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$39.13
|
| Rate for Payer: Healthspan PPO |
$34.05
|
| Rate for Payer: Humana Medicaid |
$12.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.99
|
| Rate for Payer: Molina Healthcare Passport |
$12.74
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.45
|
| Rate for Payer: UHCCP Medicaid |
$4.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.81
|
|
|
BINOCULAR MICROSCOPY(T
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 92504
|
| Hospital Charge Code |
470T0048
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.54
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
BINOCULAR MICROSCOPY(T
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 92504
|
| Hospital Charge Code |
470T0048
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem Medicaid |
$14.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.54
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Humana KY Medicaid |
$14.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
BIOCARTILAGE 1CC
|
Facility
|
OP
|
$5,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,702.50 |
| Max. Negotiated Rate |
$5,448.00 |
| Rate for Payer: Aetna Commercial |
$4,369.75
|
| Rate for Payer: Anthem Medicaid |
$1,951.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,426.50
|
| Rate for Payer: Cash Price |
$2,837.50
|
| Rate for Payer: Cigna Commercial |
$4,710.25
|
| Rate for Payer: First Health Commercial |
$5,391.25
|
| Rate for Payer: Humana Commercial |
$4,823.75
|
| Rate for Payer: Humana KY Medicaid |
$1,951.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,971.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,653.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,188.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,702.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,990.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,994.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,937.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,915.75
|
| Rate for Payer: PHCS Commercial |
$5,448.00
|
| Rate for Payer: United Healthcare All Payer |
$4,994.00
|
|
|
BIOCARTILAGE 1CC
|
Facility
|
IP
|
$5,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,702.50 |
| Max. Negotiated Rate |
$5,448.00 |
| Rate for Payer: Aetna Commercial |
$4,369.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,426.50
|
| Rate for Payer: Cash Price |
$2,837.50
|
| Rate for Payer: Cigna Commercial |
$4,710.25
|
| Rate for Payer: First Health Commercial |
$5,391.25
|
| Rate for Payer: Humana Commercial |
$4,823.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,653.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,188.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,702.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,994.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,937.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,915.75
|
| Rate for Payer: PHCS Commercial |
$5,448.00
|
| Rate for Payer: United Healthcare All Payer |
$4,994.00
|
|
|
BIOCARTILAGE KIT SMALL JOINT
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
BIOCARTILAGE KIT SMALL JOINT
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
BIOCOMP SWVLCK SP 4.7*24.5
|
Facility
|
IP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
|
BIOCOMP SWVLCK SP 4.7*24.5
|
Facility
|
OP
|
$12,124.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,637.35 |
| Max. Negotiated Rate |
$11,639.52 |
| Rate for Payer: Aetna Commercial |
$9,335.86
|
| Rate for Payer: Anthem Medicaid |
$4,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,457.11
|
| Rate for Payer: Cash Price |
$6,062.25
|
| Rate for Payer: Cigna Commercial |
$10,063.33
|
| Rate for Payer: First Health Commercial |
$11,518.27
|
| Rate for Payer: Humana Commercial |
$10,305.83
|
| Rate for Payer: Humana KY Medicaid |
$4,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,212.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,942.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,947.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,637.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,253.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,669.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,093.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,699.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,548.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,365.91
|
| Rate for Payer: PHCS Commercial |
$11,639.52
|
| Rate for Payer: United Healthcare All Payer |
$10,669.56
|
|
