|
X-FUSE IMPLANT STD 25 DEG
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
X-FUSE IMPLANT XLARGE 0 DEG
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
X-FUSE IMPLANT XLARGE 0 DEG
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
X-FUSE IMPLANT XLARGE 15 DEG
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
X-FUSE IMPLANT XLARGE 15 DEG
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
X-FUSE IMPLANT XLARGE 25 DEG
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
X-FUSE IMPLANT XLARGE 25 DEG
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
X-FUSE SIZER SMALL 0 DEG
|
Facility
|
OP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem Medicaid |
$617.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Humana KY Medicaid |
$617.13
|
| Rate for Payer: Kentucky WC Medicaid |
$623.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER SMALL 0 DEG
|
Facility
|
IP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER SMALL 15 DEG
|
Facility
|
IP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER SMALL 15 DEG
|
Facility
|
OP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem Medicaid |
$617.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Humana KY Medicaid |
$617.13
|
| Rate for Payer: Kentucky WC Medicaid |
$623.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER SMALL 25 DEG
|
Facility
|
OP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem Medicaid |
$617.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Humana KY Medicaid |
$617.13
|
| Rate for Payer: Kentucky WC Medicaid |
$623.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER SMALL 25 DEG
|
Facility
|
IP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER STD 0 DEG
|
Facility
|
OP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem Medicaid |
$617.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Humana KY Medicaid |
$617.13
|
| Rate for Payer: Kentucky WC Medicaid |
$623.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER STD 0 DEG
|
Facility
|
IP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER STD 15 DEG
|
Facility
|
OP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem Medicaid |
$617.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Humana KY Medicaid |
$617.13
|
| Rate for Payer: Kentucky WC Medicaid |
$623.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER STD 15 DEG
|
Facility
|
IP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER STD 25 DEG
|
Facility
|
IP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE SIZER STD 25 DEG
|
Facility
|
OP
|
$1,794.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$1,722.72 |
| Rate for Payer: Aetna Commercial |
$1,381.76
|
| Rate for Payer: Anthem Medicaid |
$617.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.71
|
| Rate for Payer: Cash Price |
$897.25
|
| Rate for Payer: Cigna Commercial |
$1,489.44
|
| Rate for Payer: First Health Commercial |
$1,704.78
|
| Rate for Payer: Humana Commercial |
$1,525.32
|
| Rate for Payer: Humana KY Medicaid |
$617.13
|
| Rate for Payer: Kentucky WC Medicaid |
$623.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.30
|
| Rate for Payer: PHCS Commercial |
$1,722.72
|
| Rate for Payer: United Healthcare All Payer |
$1,579.16
|
|
|
X-FUSE TRAIL XLARGE 25 DEG
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$1,739.52 |
| Rate for Payer: Aetna Commercial |
$1,395.24
|
| Rate for Payer: Anthem Medicaid |
$623.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.36
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$1,503.96
|
| Rate for Payer: First Health Commercial |
$1,721.40
|
| Rate for Payer: Humana Commercial |
$1,540.20
|
| Rate for Payer: Humana KY Medicaid |
$623.15
|
| Rate for Payer: Kentucky WC Medicaid |
$629.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.72
|
| Rate for Payer: PHCS Commercial |
$1,739.52
|
| Rate for Payer: United Healthcare All Payer |
$1,594.56
|
|
|
X-FUSE TRAIL XLARGE 25 DEG
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.56 |
| Max. Negotiated Rate |
$1,739.52 |
| Rate for Payer: Aetna Commercial |
$1,395.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.36
|
| Rate for Payer: Cash Price |
$906.00
|
| Rate for Payer: Cigna Commercial |
$1,503.96
|
| Rate for Payer: First Health Commercial |
$1,721.40
|
| Rate for Payer: Humana Commercial |
$1,540.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.72
|
| Rate for Payer: PHCS Commercial |
$1,739.52
|
| Rate for Payer: United Healthcare All Payer |
$1,594.56
|
|
|
X-FUSE TRIAL LARGE 0 DEG
|
Facility
|
OP
|
$1,808.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.10 |
| Max. Negotiated Rate |
$1,736.16 |
| Rate for Payer: Aetna Commercial |
$1,392.54
|
| Rate for Payer: Anthem Medicaid |
$621.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.63
|
| Rate for Payer: Cash Price |
$904.25
|
| Rate for Payer: Cigna Commercial |
$1,501.06
|
| Rate for Payer: First Health Commercial |
$1,718.08
|
| Rate for Payer: Humana Commercial |
$1,537.22
|
| Rate for Payer: Humana KY Medicaid |
$621.94
|
| Rate for Payer: Kentucky WC Medicaid |
$628.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.64
|
| Rate for Payer: PHCS Commercial |
$1,736.16
|
| Rate for Payer: United Healthcare All Payer |
$1,591.48
|
|
|
X-FUSE TRIAL LARGE 0 DEG
|
Facility
|
IP
|
$1,808.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.10 |
| Max. Negotiated Rate |
$1,736.16 |
| Rate for Payer: Aetna Commercial |
$1,392.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.63
|
| Rate for Payer: Cash Price |
$904.25
|
| Rate for Payer: Cigna Commercial |
$1,501.06
|
| Rate for Payer: First Health Commercial |
$1,718.08
|
| Rate for Payer: Humana Commercial |
$1,537.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.64
|
| Rate for Payer: PHCS Commercial |
$1,736.16
|
| Rate for Payer: United Healthcare All Payer |
$1,591.48
|
|
|
X-FUSE TRIAL LARGE 15 DEG
|
Facility
|
IP
|
$1,808.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.10 |
| Max. Negotiated Rate |
$1,736.16 |
| Rate for Payer: Aetna Commercial |
$1,392.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.63
|
| Rate for Payer: Cash Price |
$904.25
|
| Rate for Payer: Cigna Commercial |
$1,501.06
|
| Rate for Payer: First Health Commercial |
$1,718.08
|
| Rate for Payer: Humana Commercial |
$1,537.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.64
|
| Rate for Payer: PHCS Commercial |
$1,736.16
|
| Rate for Payer: United Healthcare All Payer |
$1,591.48
|
|
|
X-FUSE TRIAL LARGE 15 DEG
|
Facility
|
OP
|
$1,808.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.10 |
| Max. Negotiated Rate |
$1,736.16 |
| Rate for Payer: Aetna Commercial |
$1,392.54
|
| Rate for Payer: Anthem Medicaid |
$621.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.63
|
| Rate for Payer: Cash Price |
$904.25
|
| Rate for Payer: Cigna Commercial |
$1,501.06
|
| Rate for Payer: First Health Commercial |
$1,718.08
|
| Rate for Payer: Humana Commercial |
$1,537.22
|
| Rate for Payer: Humana KY Medicaid |
$621.94
|
| Rate for Payer: Kentucky WC Medicaid |
$628.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.64
|
| Rate for Payer: PHCS Commercial |
$1,736.16
|
| Rate for Payer: United Healthcare All Payer |
$1,591.48
|
|
