|
BIOLOX DELTA FEM HEAD PHA04402
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04404
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04404
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04406
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04406
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04408
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04408
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04410
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04410
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04412
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04412
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04414
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04414
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04416
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04416
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04418
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04418
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04420
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04420
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04422
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04422
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04424
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04424
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
BIOLOXDELTAHEADMD+4 12/14 40MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOXDELTAHEADMD+4 12/14 40MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
