|
X-FUSE IMPLANT STD 15 DEG
|
Facility
|
OP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem Medicaid |
$2,443.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Humana KY Medicaid |
$2,443.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
X-FUSE IMPLANT STD 25 DEG
|
Facility
|
IP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
X-FUSE IMPLANT STD 25 DEG
|
Facility
|
OP
|
$7,106.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.88 |
| Max. Negotiated Rate |
$6,822.00 |
| Rate for Payer: Aetna Commercial |
$5,471.81
|
| Rate for Payer: Anthem Medicaid |
$2,443.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.88
|
| Rate for Payer: Cash Price |
$3,553.12
|
| Rate for Payer: Cigna Commercial |
$5,898.19
|
| Rate for Payer: First Health Commercial |
$6,750.94
|
| Rate for Payer: Humana Commercial |
$6,040.31
|
| Rate for Payer: Humana KY Medicaid |
$2,443.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,182.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,903.31
|
| Rate for Payer: PHCS Commercial |
$6,822.00
|
| Rate for Payer: United Healthcare All Payer |
$6,253.50
|
|
|
X-FUSE IMPLANT XLARGE 0 DEG
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
X-FUSE IMPLANT XLARGE 0 DEG
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
X-FUSE IMPLANT XLARGE 15 DEG
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
X-FUSE IMPLANT XLARGE 15 DEG
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
X-FUSE IMPLANT XLARGE 25 DEG
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
X-FUSE IMPLANT XLARGE 25 DEG
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
X-FUSE SIZER SMALL 0 DEG
|
Facility
|
OP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem Medicaid |
$613.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Humana KY Medicaid |
$613.04
|
| Rate for Payer: Kentucky WC Medicaid |
$619.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER SMALL 0 DEG
|
Facility
|
IP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER SMALL 15 DEG
|
Facility
|
OP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem Medicaid |
$613.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Humana KY Medicaid |
$613.04
|
| Rate for Payer: Kentucky WC Medicaid |
$619.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER SMALL 15 DEG
|
Facility
|
IP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER SMALL 25 DEG
|
Facility
|
IP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER SMALL 25 DEG
|
Facility
|
OP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem Medicaid |
$613.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Humana KY Medicaid |
$613.04
|
| Rate for Payer: Kentucky WC Medicaid |
$619.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER STD 0 DEG
|
Facility
|
OP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem Medicaid |
$613.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Humana KY Medicaid |
$613.04
|
| Rate for Payer: Kentucky WC Medicaid |
$619.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER STD 0 DEG
|
Facility
|
IP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER STD 15 DEG
|
Facility
|
IP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER STD 15 DEG
|
Facility
|
OP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem Medicaid |
$613.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Humana KY Medicaid |
$613.04
|
| Rate for Payer: Kentucky WC Medicaid |
$619.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER STD 25 DEG
|
Facility
|
IP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE SIZER STD 25 DEG
|
Facility
|
OP
|
$1,782.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,711.30 |
| Rate for Payer: Aetna Commercial |
$1,372.60
|
| Rate for Payer: Anthem Medicaid |
$613.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.43
|
| Rate for Payer: Cash Price |
$891.30
|
| Rate for Payer: Cigna Commercial |
$1,479.56
|
| Rate for Payer: First Health Commercial |
$1,693.47
|
| Rate for Payer: Humana Commercial |
$1,515.21
|
| Rate for Payer: Humana KY Medicaid |
$613.04
|
| Rate for Payer: Kentucky WC Medicaid |
$619.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,461.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,568.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,336.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,229.99
|
| Rate for Payer: PHCS Commercial |
$1,711.30
|
| Rate for Payer: United Healthcare All Payer |
$1,568.69
|
|
|
X-FUSE TRAIL XLARGE 25 DEG
|
Facility
|
OP
|
$1,801.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.48 |
| Max. Negotiated Rate |
$1,729.54 |
| Rate for Payer: Aetna Commercial |
$1,387.23
|
| Rate for Payer: Anthem Medicaid |
$619.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.25
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cigna Commercial |
$1,495.33
|
| Rate for Payer: First Health Commercial |
$1,711.52
|
| Rate for Payer: Humana Commercial |
$1,531.36
|
| Rate for Payer: Humana KY Medicaid |
$619.57
|
| Rate for Payer: Kentucky WC Medicaid |
$625.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.10
|
| Rate for Payer: PHCS Commercial |
$1,729.54
|
| Rate for Payer: United Healthcare All Payer |
$1,585.41
|
|
|
X-FUSE TRAIL XLARGE 25 DEG
|
Facility
|
IP
|
$1,801.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.48 |
| Max. Negotiated Rate |
$1,729.54 |
| Rate for Payer: Aetna Commercial |
$1,387.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.25
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cigna Commercial |
$1,495.33
|
| Rate for Payer: First Health Commercial |
$1,711.52
|
| Rate for Payer: Humana Commercial |
$1,531.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.10
|
| Rate for Payer: PHCS Commercial |
$1,729.54
|
| Rate for Payer: United Healthcare All Payer |
$1,585.41
|
|
|
X-FUSE TRIAL LARGE 0 DEG
|
Facility
|
OP
|
$1,797.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.34 |
| Max. Negotiated Rate |
$1,725.89 |
| Rate for Payer: Aetna Commercial |
$1,384.31
|
| Rate for Payer: Anthem Medicaid |
$618.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.28
|
| Rate for Payer: Cash Price |
$898.90
|
| Rate for Payer: Cigna Commercial |
$1,492.17
|
| Rate for Payer: First Health Commercial |
$1,707.91
|
| Rate for Payer: Humana Commercial |
$1,528.13
|
| Rate for Payer: Humana KY Medicaid |
$618.26
|
| Rate for Payer: Kentucky WC Medicaid |
$624.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.48
|
| Rate for Payer: PHCS Commercial |
$1,725.89
|
| Rate for Payer: United Healthcare All Payer |
$1,582.06
|
|
|
X-FUSE TRIAL LARGE 0 DEG
|
Facility
|
IP
|
$1,797.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.34 |
| Max. Negotiated Rate |
$1,725.89 |
| Rate for Payer: Aetna Commercial |
$1,384.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.28
|
| Rate for Payer: Cash Price |
$898.90
|
| Rate for Payer: Cigna Commercial |
$1,492.17
|
| Rate for Payer: First Health Commercial |
$1,707.91
|
| Rate for Payer: Humana Commercial |
$1,528.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.48
|
| Rate for Payer: PHCS Commercial |
$1,725.89
|
| Rate for Payer: United Healthcare All Payer |
$1,582.06
|
|
