|
CUP RESTORATION ADM 50MM RIGHT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 52MM LEFT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 52MM LEFT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 52MM RIGHT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 52MM RIGHT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 54MM LEFT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 54MM LEFT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 54MM RIGHT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 54MM RIGHT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 56MM LEFT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 56MM LEFT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 56MM RIGHT
|
Facility
|
IP
|
$17,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,125.08 |
| Max. Negotiated Rate |
$16,400.26 |
| Rate for Payer: Aetna Commercial |
$13,154.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,325.21
|
| Rate for Payer: Cash Price |
$8,541.80
|
| Rate for Payer: Cigna Commercial |
$14,179.39
|
| Rate for Payer: First Health Commercial |
$16,229.42
|
| Rate for Payer: Humana Commercial |
$14,521.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,008.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,607.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,125.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,033.57
|
| Rate for Payer: Ohio Health Group HMO |
$12,812.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,666.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,862.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,787.68
|
| Rate for Payer: PHCS Commercial |
$16,400.26
|
| Rate for Payer: United Healthcare All Payer |
$15,033.57
|
|
|
CUP RESTORATION ADM 56MM RIGHT
|
Facility
|
OP
|
$17,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,125.08 |
| Max. Negotiated Rate |
$16,400.26 |
| Rate for Payer: Aetna Commercial |
$13,154.37
|
| Rate for Payer: Anthem Medicaid |
$5,875.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,325.21
|
| Rate for Payer: Cash Price |
$8,541.80
|
| Rate for Payer: Cigna Commercial |
$14,179.39
|
| Rate for Payer: First Health Commercial |
$16,229.42
|
| Rate for Payer: Humana Commercial |
$14,521.06
|
| Rate for Payer: Humana KY Medicaid |
$5,875.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,934.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,008.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,607.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,125.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,992.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,033.57
|
| Rate for Payer: Ohio Health Group HMO |
$12,812.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,666.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,862.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,787.68
|
| Rate for Payer: PHCS Commercial |
$16,400.26
|
| Rate for Payer: United Healthcare All Payer |
$15,033.57
|
|
|
CUP RESTORATION ADM 58MM LEFT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 58MM LEFT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 58MM RIGHT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 58MM RIGHT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 60MM LEFT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 60MM LEFT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 60MM RIGHT
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 60MM RIGHT
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
CUP RESTORATION ADM 62MM LEFT
|
Facility
|
OP
|
$17,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,125.08 |
| Max. Negotiated Rate |
$16,400.26 |
| Rate for Payer: Aetna Commercial |
$13,154.37
|
| Rate for Payer: Anthem Medicaid |
$5,875.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,325.21
|
| Rate for Payer: Cash Price |
$8,541.80
|
| Rate for Payer: Cigna Commercial |
$14,179.39
|
| Rate for Payer: First Health Commercial |
$16,229.42
|
| Rate for Payer: Humana Commercial |
$14,521.06
|
| Rate for Payer: Humana KY Medicaid |
$5,875.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,934.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,008.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,607.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,125.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,992.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,033.57
|
| Rate for Payer: Ohio Health Group HMO |
$12,812.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,666.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,862.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,787.68
|
| Rate for Payer: PHCS Commercial |
$16,400.26
|
| Rate for Payer: United Healthcare All Payer |
$15,033.57
|
|
|
CUP RESTORATION ADM 62MM LEFT
|
Facility
|
IP
|
$17,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,125.08 |
| Max. Negotiated Rate |
$16,400.26 |
| Rate for Payer: Aetna Commercial |
$13,154.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,325.21
|
| Rate for Payer: Cash Price |
$8,541.80
|
| Rate for Payer: Cigna Commercial |
$14,179.39
|
| Rate for Payer: First Health Commercial |
$16,229.42
|
| Rate for Payer: Humana Commercial |
$14,521.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,008.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,607.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,125.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,033.57
|
| Rate for Payer: Ohio Health Group HMO |
$12,812.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,666.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,862.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,787.68
|
| Rate for Payer: PHCS Commercial |
$16,400.26
|
| Rate for Payer: United Healthcare All Payer |
$15,033.57
|
|
|
CUP RESTORATION ADM 62MM RIGHT
|
Facility
|
OP
|
$17,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,125.08 |
| Max. Negotiated Rate |
$16,400.26 |
| Rate for Payer: Aetna Commercial |
$13,154.37
|
| Rate for Payer: Anthem Medicaid |
$5,875.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,325.21
|
| Rate for Payer: Cash Price |
$8,541.80
|
| Rate for Payer: Cigna Commercial |
$14,179.39
|
| Rate for Payer: First Health Commercial |
$16,229.42
|
| Rate for Payer: Humana Commercial |
$14,521.06
|
| Rate for Payer: Humana KY Medicaid |
$5,875.05
|
| Rate for Payer: Kentucky WC Medicaid |
$5,934.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,008.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,607.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,125.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,992.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,033.57
|
| Rate for Payer: Ohio Health Group HMO |
$12,812.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,666.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,862.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,787.68
|
| Rate for Payer: PHCS Commercial |
$16,400.26
|
| Rate for Payer: United Healthcare All Payer |
$15,033.57
|
|
|
CUP RESTORATION ADM 62MM RIGHT
|
Facility
|
IP
|
$17,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,125.08 |
| Max. Negotiated Rate |
$16,400.26 |
| Rate for Payer: Aetna Commercial |
$13,154.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,325.21
|
| Rate for Payer: Cash Price |
$8,541.80
|
| Rate for Payer: Cigna Commercial |
$14,179.39
|
| Rate for Payer: First Health Commercial |
$16,229.42
|
| Rate for Payer: Humana Commercial |
$14,521.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,008.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,607.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,125.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,033.57
|
| Rate for Payer: Ohio Health Group HMO |
$12,812.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,666.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,862.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,787.68
|
| Rate for Payer: PHCS Commercial |
$16,400.26
|
| Rate for Payer: United Healthcare All Payer |
$15,033.57
|
|
