|
VEGA AS TIB EXT STEM 12*52MM
|
Facility
|
IP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
VEGA FEMUR SZ F5N L66.5*8
|
Facility
|
OP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem Medicaid |
$5,255.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Humana KY Medicaid |
$5,255.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
VEGA FEMUR SZ F5N L66.5*8
|
Facility
|
IP
|
$15,282.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.78 |
| Max. Negotiated Rate |
$14,671.64 |
| Rate for Payer: Aetna Commercial |
$11,767.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.71
|
| Rate for Payer: Cash Price |
$7,641.48
|
| Rate for Payer: Cigna Commercial |
$12,684.86
|
| Rate for Payer: First Health Commercial |
$14,518.81
|
| Rate for Payer: Humana Commercial |
$12,990.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,532.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,449.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,462.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.72
|
| Rate for Payer: PHCS Commercial |
$14,671.64
|
| Rate for Payer: United Healthcare All Payer |
$13,449.00
|
|
|
VEGA PATELLA 3 PEGS P3
|
Facility
|
IP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
VEGA PATELLA 3 PEGS P3
|
Facility
|
OP
|
$4,694.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.32 |
| Max. Negotiated Rate |
$4,507.01 |
| Rate for Payer: Aetna Commercial |
$3,615.00
|
| Rate for Payer: Anthem Medicaid |
$1,614.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.94
|
| Rate for Payer: Cash Price |
$2,347.40
|
| Rate for Payer: Cigna Commercial |
$3,896.68
|
| Rate for Payer: First Health Commercial |
$4,460.06
|
| Rate for Payer: Humana Commercial |
$3,990.58
|
| Rate for Payer: Humana KY Medicaid |
$1,614.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,646.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,131.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.39
|
| Rate for Payer: PHCS Commercial |
$4,507.01
|
| Rate for Payer: United Healthcare All Payer |
$4,131.42
|
|
|
VEGA PS GLIDING SURF T3/T3+ 10
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDING SURF T3/T3+ 10
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDING SURF T3/T3+ 12
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDING SURF T3/T3+ 12
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDING SURF TT2/2+10M
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDING SURF TT2/2+10M
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDNG SRF T3/T3+ 20MM
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA PS GLIDNG SRF T3/T3+ 20MM
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
VEGA TIBIA PLATEAU CEM T2 70*4
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
VEGA TIBIA PLATEAU CEM T2 70*4
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
VEIN BYPASS GRAFT
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35372
|
| Hospital Charge Code |
76101389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
VEIN BYPASS GRAFT
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35372
|
| Hospital Charge Code |
76101389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
VEIN BYPASS GRAFT
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35583
|
| Hospital Charge Code |
76101403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VEIN BYPASS GRAFT
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35372
|
| Hospital Charge Code |
76101389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$716.15 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,751.15
|
| Rate for Payer: Anthem Medicaid |
$716.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,685.99
|
| Rate for Payer: Healthspan PPO |
$1,721.73
|
| Rate for Payer: Humana Medicaid |
$716.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,348.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$730.47
|
| Rate for Payer: Molina Healthcare Passport |
$716.15
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$723.31
|
|
|
VEIN BYPASS GRAFT
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35585
|
| Hospital Charge Code |
76101404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VEIN BYPASS GRAFT
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35585
|
| Hospital Charge Code |
76101404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,951.13
|
| Rate for Payer: Anthem Medicaid |
$1,287.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,811.07
|
| Rate for Payer: Healthspan PPO |
$2,901.54
|
| Rate for Payer: Humana Medicaid |
$1,287.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,311.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,312.80
|
| Rate for Payer: Molina Healthcare Passport |
$1,287.06
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,299.93
|
|
|
VEIN BYPASS GRAFT
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35583
|
| Hospital Charge Code |
76101403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,510.52
|
| Rate for Payer: Anthem Medicaid |
$1,117.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,379.76
|
| Rate for Payer: Healthspan PPO |
$2,468.33
|
| Rate for Payer: Humana Medicaid |
$1,117.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,987.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,139.55
|
| Rate for Payer: Molina Healthcare Passport |
$1,117.21
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,128.38
|
|
|
VEIN BYPASS GRAFT
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35585
|
| Hospital Charge Code |
76101404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VEIN BYPASS GRAFT
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35583
|
| Hospital Charge Code |
76101403
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VEIN BYPASS GRAFT(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 35585
|
| Hospital Charge Code |
761P1404
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,951.13
|
| Rate for Payer: Anthem Medicaid |
$1,287.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,811.07
|
| Rate for Payer: Healthspan PPO |
$2,901.54
|
| Rate for Payer: Humana Medicaid |
$1,287.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,311.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,312.80
|
| Rate for Payer: Molina Healthcare Passport |
$1,287.06
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,299.93
|
|
