|
CEMENTRALIZER 17.5
|
Facility
|
OP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem Medicaid |
$684.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Humana KY Medicaid |
$684.91
|
| Rate for Payer: Kentucky WC Medicaid |
$691.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
|
CEMENTRALIZER 18.0
|
Facility
|
IP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
|
CEMENTRALIZER 18.0
|
Facility
|
OP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem Medicaid |
$684.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Humana KY Medicaid |
$684.91
|
| Rate for Payer: Kentucky WC Medicaid |
$691.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
|
CEMENTRALIZER 19.0
|
Facility
|
OP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem Medicaid |
$684.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Humana KY Medicaid |
$684.91
|
| Rate for Payer: Kentucky WC Medicaid |
$691.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
|
CEMENTRALIZER 19.0
|
Facility
|
IP
|
$1,991.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.48 |
| Max. Negotiated Rate |
$1,911.94 |
| Rate for Payer: Aetna Commercial |
$1,533.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,553.45
|
| Rate for Payer: Cash Price |
$995.80
|
| Rate for Payer: Cigna Commercial |
$1,653.03
|
| Rate for Payer: First Health Commercial |
$1,892.02
|
| Rate for Payer: Humana Commercial |
$1,692.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,633.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,752.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,593.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,732.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.20
|
| Rate for Payer: PHCS Commercial |
$1,911.94
|
| Rate for Payer: United Healthcare All Payer |
$1,752.61
|
|
|
CEMENTRALIZER 8.5MM
|
Facility
|
IP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
CEMENTRALIZER 8.5MM
|
Facility
|
OP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem Medicaid |
$700.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Humana KY Medicaid |
$700.59
|
| Rate for Payer: Kentucky WC Medicaid |
$707.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
CEMENTRALIZER 9.25
|
Facility
|
OP
|
$1,963.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.18 |
| Max. Negotiated Rate |
$1,885.38 |
| Rate for Payer: Aetna Commercial |
$1,512.23
|
| Rate for Payer: Anthem Medicaid |
$675.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,531.87
|
| Rate for Payer: Cash Price |
$981.97
|
| Rate for Payer: Cigna Commercial |
$1,630.07
|
| Rate for Payer: First Health Commercial |
$1,865.74
|
| Rate for Payer: Humana Commercial |
$1,669.35
|
| Rate for Payer: Humana KY Medicaid |
$675.40
|
| Rate for Payer: Kentucky WC Medicaid |
$682.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,610.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,728.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,472.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,708.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.12
|
| Rate for Payer: PHCS Commercial |
$1,885.38
|
| Rate for Payer: United Healthcare All Payer |
$1,728.27
|
|
|
CEMENTRALIZER 9.25
|
Facility
|
IP
|
$1,963.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.18 |
| Max. Negotiated Rate |
$1,885.38 |
| Rate for Payer: Aetna Commercial |
$1,512.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,531.87
|
| Rate for Payer: Cash Price |
$981.97
|
| Rate for Payer: Cigna Commercial |
$1,630.07
|
| Rate for Payer: First Health Commercial |
$1,865.74
|
| Rate for Payer: Humana Commercial |
$1,669.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,610.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,449.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,728.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,472.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,708.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.12
|
| Rate for Payer: PHCS Commercial |
$1,885.38
|
| Rate for Payer: United Healthcare All Payer |
$1,728.27
|
|
|
CEMENT RESTRICTOR BIOSTOP G 10
|
Facility
|
IP
|
$2,223.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.02 |
| Max. Negotiated Rate |
$2,134.46 |
| Rate for Payer: Aetna Commercial |
$1,712.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,734.25
|
| Rate for Payer: Cash Price |
$1,111.70
|
| Rate for Payer: Cigna Commercial |
$1,845.42
|
| Rate for Payer: First Health Commercial |
$2,112.23
|
| Rate for Payer: Humana Commercial |
$1,889.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,823.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,956.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,667.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,934.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.15
|
| Rate for Payer: PHCS Commercial |
$2,134.46
|
| Rate for Payer: United Healthcare All Payer |
$1,956.59
|
|
|
CEMENT RESTRICTOR BIOSTOP G 10
|
Facility
|
OP
|
$2,223.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.02 |
| Max. Negotiated Rate |
$2,134.46 |
| Rate for Payer: Aetna Commercial |
$1,712.02
|
| Rate for Payer: Anthem Medicaid |
$764.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,734.25
|
| Rate for Payer: Cash Price |
$1,111.70
|
| Rate for Payer: Cigna Commercial |
$1,845.42
|
| Rate for Payer: First Health Commercial |
$2,112.23
|
| Rate for Payer: Humana Commercial |
$1,889.89
|
| Rate for Payer: Humana KY Medicaid |
$764.63
|
| Rate for Payer: Kentucky WC Medicaid |
$772.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,823.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$779.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,956.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,667.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,934.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.15
|
| Rate for Payer: PHCS Commercial |
$2,134.46
|
| Rate for Payer: United Healthcare All Payer |
$1,956.59
|
|
|
CEMENT RESTRICTOR BIOSTOP G 12
|
Facility
|
IP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 12
|
Facility
|
OP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem Medicaid |
$748.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Humana KY Medicaid |
$748.95
|
| Rate for Payer: Kentucky WC Medicaid |
$756.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 14
|
Facility
|
OP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem Medicaid |
$748.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Humana KY Medicaid |
$748.95
|
| Rate for Payer: Kentucky WC Medicaid |
$756.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 14
|
Facility
|
IP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 16
|
Facility
|
IP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 16
|
Facility
|
OP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem Medicaid |
$748.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Humana KY Medicaid |
$748.95
|
| Rate for Payer: Kentucky WC Medicaid |
$756.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 18
|
Facility
|
OP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem Medicaid |
$748.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Humana KY Medicaid |
$748.95
|
| Rate for Payer: Kentucky WC Medicaid |
$756.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 18
|
Facility
|
IP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 20
|
Facility
|
OP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem Medicaid |
$748.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Humana KY Medicaid |
$748.95
|
| Rate for Payer: Kentucky WC Medicaid |
$756.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 20
|
Facility
|
IP
|
$2,177.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.34 |
| Max. Negotiated Rate |
$2,090.69 |
| Rate for Payer: Aetna Commercial |
$1,676.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.68
|
| Rate for Payer: Cash Price |
$1,088.90
|
| Rate for Payer: Cigna Commercial |
$1,807.57
|
| Rate for Payer: First Health Commercial |
$2,068.91
|
| Rate for Payer: Humana Commercial |
$1,851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,916.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.68
|
| Rate for Payer: PHCS Commercial |
$2,090.69
|
| Rate for Payer: United Healthcare All Payer |
$1,916.46
|
|
|
CEMENT RESTRICTOR BIOSTOP G 8M
|
Facility
|
IP
|
$2,223.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.02 |
| Max. Negotiated Rate |
$2,134.46 |
| Rate for Payer: Aetna Commercial |
$1,712.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,734.25
|
| Rate for Payer: Cash Price |
$1,111.70
|
| Rate for Payer: Cigna Commercial |
$1,845.42
|
| Rate for Payer: First Health Commercial |
$2,112.23
|
| Rate for Payer: Humana Commercial |
$1,889.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,823.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,956.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,667.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,934.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.15
|
| Rate for Payer: PHCS Commercial |
$2,134.46
|
| Rate for Payer: United Healthcare All Payer |
$1,956.59
|
|
|
CEMENT RESTRICTOR BIOSTOP G 8M
|
Facility
|
OP
|
$2,223.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.02 |
| Max. Negotiated Rate |
$2,134.46 |
| Rate for Payer: Aetna Commercial |
$1,712.02
|
| Rate for Payer: Anthem Medicaid |
$764.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,734.25
|
| Rate for Payer: Cash Price |
$1,111.70
|
| Rate for Payer: Cigna Commercial |
$1,845.42
|
| Rate for Payer: First Health Commercial |
$2,112.23
|
| Rate for Payer: Humana Commercial |
$1,889.89
|
| Rate for Payer: Humana KY Medicaid |
$764.63
|
| Rate for Payer: Kentucky WC Medicaid |
$772.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,823.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$779.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,956.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,667.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,934.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.15
|
| Rate for Payer: PHCS Commercial |
$2,134.46
|
| Rate for Payer: United Healthcare All Payer |
$1,956.59
|
|
|
CEMENT SIMPLEX HV 6194-1-010
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem Medicaid |
$386.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Humana KY Medicaid |
$386.89
|
| Rate for Payer: Kentucky WC Medicaid |
$390.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
CEMENT SIMPLEX HV 6194-1-010
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.25
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
