|
CULTURE URINE QUANT
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
30001272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CULTURE URINE QUANT
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
30001272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$7.19
|
| Rate for Payer: Healthspan PPO |
$8.46
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.84
|
|
|
CULTURE URINE QUANT
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
30001272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$8.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.07
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$8.07
|
| Rate for Payer: Humana Medicare Advantage |
$8.07
|
| Rate for Payer: Kentucky WC Medicaid |
$8.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CULTUREWOUND W/ISOLATE & ID
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$13.26 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem Medicaid |
$9.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.47
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Humana KY Medicaid |
$9.47
|
| Rate for Payer: Humana Medicare Advantage |
$9.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
CULTUREWOUND W/ISOLATE & ID
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS 87075
|
| Hospital Charge Code |
30001256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: Aetna Commercial |
$7.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.03
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna Commercial |
$8.30
|
| Rate for Payer: First Health Commercial |
$9.50
|
| Rate for Payer: Humana Commercial |
$8.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.80
|
| Rate for Payer: Ohio Health Group HMO |
$7.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Payer |
$8.80
|
|
|
CUP RESTORATION ADM 46MM LEFT
|
Facility
|
OP
|
$16,540.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.30 |
| Max. Negotiated Rate |
$15,879.17 |
| Rate for Payer: Aetna Commercial |
$12,736.42
|
| Rate for Payer: Anthem Medicaid |
$5,688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.82
|
| Rate for Payer: Cash Price |
$8,270.40
|
| Rate for Payer: Cigna Commercial |
$13,728.86
|
| Rate for Payer: First Health Commercial |
$15,713.76
|
| Rate for Payer: Humana Commercial |
$14,059.68
|
| Rate for Payer: Humana KY Medicaid |
$5,688.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,563.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,207.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,802.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.65
|
| Rate for Payer: PHCS Commercial |
$15,879.17
|
| Rate for Payer: United Healthcare All Payer |
$14,555.90
|
|
|
CUP RESTORATION ADM 46MM LEFT
|
Facility
|
IP
|
$16,540.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.30 |
| Max. Negotiated Rate |
$15,879.17 |
| Rate for Payer: Aetna Commercial |
$12,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.82
|
| Rate for Payer: Cash Price |
$8,270.40
|
| Rate for Payer: Cigna Commercial |
$13,728.86
|
| Rate for Payer: First Health Commercial |
$15,713.76
|
| Rate for Payer: Humana Commercial |
$14,059.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,563.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,207.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.65
|
| Rate for Payer: PHCS Commercial |
$15,879.17
|
| Rate for Payer: United Healthcare All Payer |
$14,555.90
|
|
|
CUP RESTORATION ADM 46MM RIGHT
|
Facility
|
OP
|
$16,540.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.30 |
| Max. Negotiated Rate |
$15,879.17 |
| Rate for Payer: Aetna Commercial |
$12,736.42
|
| Rate for Payer: Anthem Medicaid |
$5,688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.82
|
| Rate for Payer: Cash Price |
$8,270.40
|
| Rate for Payer: Cigna Commercial |
$13,728.86
|
| Rate for Payer: First Health Commercial |
$15,713.76
|
| Rate for Payer: Humana Commercial |
$14,059.68
|
| Rate for Payer: Humana KY Medicaid |
$5,688.38
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,563.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,207.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,802.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.65
|
| Rate for Payer: PHCS Commercial |
$15,879.17
|
| Rate for Payer: United Healthcare All Payer |
$14,555.90
|
|
|
CUP RESTORATION ADM 46MM RIGHT
|
Facility
|
IP
|
$16,540.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.30 |
| Max. Negotiated Rate |
$15,879.17 |
| Rate for Payer: Aetna Commercial |
$12,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,901.82
|
| Rate for Payer: Cash Price |
$8,270.40
|
| Rate for Payer: Cigna Commercial |
$13,728.86
|
| Rate for Payer: First Health Commercial |
$15,713.76
|
| Rate for Payer: Humana Commercial |
$14,059.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,563.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,207.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,962.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,555.90
|
| Rate for Payer: Ohio Health Group HMO |
$12,405.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,308.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,150.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,127.65
|
| Rate for Payer: PHCS Commercial |
$15,879.17
|
| Rate for Payer: United Healthcare All Payer |
$14,555.90
|
|
|
CUP RESTORATION ADM 48MM LEFT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 48MM LEFT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 48MM RIGHT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 48MM RIGHT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 50MM LEFT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 50MM LEFT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 50MM RIGHT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 50MM RIGHT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 52MM LEFT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 52MM LEFT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 52MM RIGHT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 52MM RIGHT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 54MM LEFT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 54MM LEFT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 54MM RIGHT
|
Facility
|
OP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem Medicaid |
$4,260.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Humana KY Medicaid |
$4,260.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,303.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,345.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
|
CUP RESTORATION ADM 54MM RIGHT
|
Facility
|
IP
|
$12,388.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.50 |
| Max. Negotiated Rate |
$11,892.96 |
| Rate for Payer: Aetna Commercial |
$9,539.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,663.03
|
| Rate for Payer: Cash Price |
$6,194.25
|
| Rate for Payer: Cigna Commercial |
$10,282.46
|
| Rate for Payer: First Health Commercial |
$11,769.08
|
| Rate for Payer: Humana Commercial |
$10,530.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,158.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,142.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,716.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,901.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,291.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,477.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.44
|
| Rate for Payer: PHCS Commercial |
$11,892.96
|
| Rate for Payer: United Healthcare All Payer |
$10,901.88
|
|
