|
CEMENTRALIZER 16.0
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 17.0
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 17.0
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem Medicaid |
$683.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Humana KY Medicaid |
$683.33
|
| Rate for Payer: Kentucky WC Medicaid |
$690.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 17.5
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 17.5
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem Medicaid |
$683.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Humana KY Medicaid |
$683.33
|
| Rate for Payer: Kentucky WC Medicaid |
$690.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 18.0
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem Medicaid |
$683.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Humana KY Medicaid |
$683.33
|
| Rate for Payer: Kentucky WC Medicaid |
$690.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 18.0
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 19.0
|
Facility
|
OP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem Medicaid |
$683.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Humana KY Medicaid |
$683.33
|
| Rate for Payer: Kentucky WC Medicaid |
$690.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 19.0
|
Facility
|
IP
|
$1,987.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.31 |
| Max. Negotiated Rate |
$1,907.52 |
| Rate for Payer: Aetna Commercial |
$1,529.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,549.86
|
| Rate for Payer: Cash Price |
$993.50
|
| Rate for Payer: Cigna Commercial |
$1,649.21
|
| Rate for Payer: First Health Commercial |
$1,887.65
|
| Rate for Payer: Humana Commercial |
$1,688.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,629.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,466.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,748.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.97
|
| Rate for Payer: PHCS Commercial |
$1,907.52
|
| Rate for Payer: United Healthcare All Payer |
$1,748.56
|
|
|
CEMENTRALIZER 8.5MM
|
Facility
|
IP
|
$2,029.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$1,947.84 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
CEMENTRALIZER 8.5MM
|
Facility
|
OP
|
$2,029.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.77 |
| Max. Negotiated Rate |
$1,947.84 |
| Rate for Payer: Aetna Commercial |
$1,562.33
|
| Rate for Payer: Anthem Medicaid |
$697.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.62
|
| Rate for Payer: Cash Price |
$1,014.50
|
| Rate for Payer: Cigna Commercial |
$1,684.07
|
| Rate for Payer: First Health Commercial |
$1,927.55
|
| Rate for Payer: Humana Commercial |
$1,724.65
|
| Rate for Payer: Humana KY Medicaid |
$697.77
|
| Rate for Payer: Kentucky WC Medicaid |
$704.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$628.99
|
| Rate for Payer: PHCS Commercial |
$1,947.84
|
| Rate for Payer: United Healthcare All Payer |
$1,785.52
|
|
|
CEMENTRALIZER 9.25
|
Facility
|
OP
|
$1,961.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$1,883.06 |
| Rate for Payer: Aetna Commercial |
$1,510.37
|
| Rate for Payer: Anthem Medicaid |
$674.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,529.99
|
| Rate for Payer: Cash Price |
$980.76
|
| Rate for Payer: Cigna Commercial |
$1,628.06
|
| Rate for Payer: First Health Commercial |
$1,863.44
|
| Rate for Payer: Humana Commercial |
$1,667.29
|
| Rate for Payer: Humana KY Medicaid |
$674.57
|
| Rate for Payer: Kentucky WC Medicaid |
$681.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,608.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,447.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,726.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.07
|
| Rate for Payer: PHCS Commercial |
$1,883.06
|
| Rate for Payer: United Healthcare All Payer |
$1,726.14
|
|
|
CEMENTRALIZER 9.25
|
Facility
|
IP
|
$1,961.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$1,883.06 |
| Rate for Payer: Aetna Commercial |
$1,510.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,529.99
|
| Rate for Payer: Cash Price |
$980.76
|
| Rate for Payer: Cigna Commercial |
$1,628.06
|
| Rate for Payer: First Health Commercial |
$1,863.44
|
| Rate for Payer: Humana Commercial |
$1,667.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,608.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,447.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,726.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.07
|
| Rate for Payer: PHCS Commercial |
$1,883.06
|
| Rate for Payer: United Healthcare All Payer |
$1,726.14
|
|
|
CEMENT RESTRICTOR BIOSTOP G 10
|
Facility
|
IP
|
$2,200.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$2,112.48 |
| Rate for Payer: Aetna Commercial |
$1,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.39
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna Commercial |
$1,826.42
|
| Rate for Payer: First Health Commercial |
$2,090.48
|
| Rate for Payer: Humana Commercial |
$1,870.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.16
|
| Rate for Payer: PHCS Commercial |
$2,112.48
|
| Rate for Payer: United Healthcare All Payer |
$1,936.44
|
|
|
CEMENT RESTRICTOR BIOSTOP G 10
|
Facility
|
OP
|
$2,200.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$2,112.48 |
| Rate for Payer: Aetna Commercial |
$1,694.38
|
| Rate for Payer: Anthem Medicaid |
$756.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.39
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna Commercial |
$1,826.42
|
| Rate for Payer: First Health Commercial |
$2,090.48
|
| Rate for Payer: Humana Commercial |
$1,870.42
|
| Rate for Payer: Humana KY Medicaid |
$756.75
|
| Rate for Payer: Kentucky WC Medicaid |
$764.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.16
|
| Rate for Payer: PHCS Commercial |
$2,112.48
|
| Rate for Payer: United Healthcare All Payer |
$1,936.44
|
|
|
CEMENT RESTRICTOR BIOSTOP G 12
|
Facility
|
IP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 12
|
Facility
|
OP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem Medicaid |
$742.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Humana KY Medicaid |
$742.31
|
| Rate for Payer: Kentucky WC Medicaid |
$749.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 14
|
Facility
|
OP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem Medicaid |
$742.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Humana KY Medicaid |
$742.31
|
| Rate for Payer: Kentucky WC Medicaid |
$749.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 14
|
Facility
|
IP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 16
|
Facility
|
IP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 16
|
Facility
|
OP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem Medicaid |
$742.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Humana KY Medicaid |
$742.31
|
| Rate for Payer: Kentucky WC Medicaid |
$749.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 18
|
Facility
|
OP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem Medicaid |
$742.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Humana KY Medicaid |
$742.31
|
| Rate for Payer: Kentucky WC Medicaid |
$749.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 18
|
Facility
|
IP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 20
|
Facility
|
OP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem Medicaid |
$742.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Humana KY Medicaid |
$742.31
|
| Rate for Payer: Kentucky WC Medicaid |
$749.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
|
CEMENT RESTRICTOR BIOSTOP G 20
|
Facility
|
IP
|
$2,158.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$2,072.16 |
| Rate for Payer: Aetna Commercial |
$1,662.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.63
|
| Rate for Payer: Cash Price |
$1,079.25
|
| Rate for Payer: Cigna Commercial |
$1,791.56
|
| Rate for Payer: First Health Commercial |
$2,050.58
|
| Rate for Payer: Humana Commercial |
$1,834.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.14
|
| Rate for Payer: PHCS Commercial |
$2,072.16
|
| Rate for Payer: United Healthcare All Payer |
$1,899.48
|
|
