|
ADV TIBIA BASE W/HOLES SZ3+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE W/HOLES SZ4+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE W/HOLES SZ4+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE W/HOLES SZ5+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE W/HOLES SZ5+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ1+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ1+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ2+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ2+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ3+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ3+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ4+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ4+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ5+
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
ADV TIBIA BASE WO HOLE SZ5+
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
470T0071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$19.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$19.95
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
AEP HEARING STATUS DETER I&R
|
Professional
|
Both
|
$138.68
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
47000071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.54 |
| Max. Negotiated Rate |
$138.68 |
| Rate for Payer: Anthem Medicaid |
$71.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.68
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Humana Medicaid |
$71.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.42
|
| Rate for Payer: Molina Healthcare Passport |
$71.00
|
| Rate for Payer: Multiplan PHCS |
$83.21
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.08
|
| Rate for Payer: UHCCP Medicaid |
$48.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.71
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
IP
|
$138.68
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
47000071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$133.13 |
| Rate for Payer: Aetna Commercial |
$106.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.17
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cigna Commercial |
$115.10
|
| Rate for Payer: First Health Commercial |
$131.75
|
| Rate for Payer: Humana Commercial |
$117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.04
|
| Rate for Payer: Ohio Health Group HMO |
$104.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.99
|
| Rate for Payer: PHCS Commercial |
$133.13
|
| Rate for Payer: United Healthcare All Payer |
$122.04
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
OP
|
$138.68
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
47000071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$106.78
|
| Rate for Payer: Anthem Medicaid |
$47.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cash Price |
$69.34
|
| Rate for Payer: Cigna Commercial |
$115.10
|
| Rate for Payer: First Health Commercial |
$131.75
|
| Rate for Payer: Humana Commercial |
$117.88
|
| Rate for Payer: Humana KY Medicaid |
$47.69
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$48.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.04
|
| Rate for Payer: Ohio Health Group HMO |
$104.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.99
|
| Rate for Payer: PHCS Commercial |
$133.13
|
| Rate for Payer: United Healthcare All Payer |
$122.04
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
470T0071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
AEP HEARING STATUS DETER I&R
|
Professional
|
Both
|
$80.68
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
470P0071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.24 |
| Max. Negotiated Rate |
$80.68 |
| Rate for Payer: Anthem Medicaid |
$71.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.68
|
| Rate for Payer: Cash Price |
$40.34
|
| Rate for Payer: Cash Price |
$40.34
|
| Rate for Payer: Humana Medicaid |
$71.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.42
|
| Rate for Payer: Molina Healthcare Passport |
$71.00
|
| Rate for Payer: Multiplan PHCS |
$48.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.48
|
| Rate for Payer: UHCCP Medicaid |
$28.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.71
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Professional
|
Both
|
$264.26
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
47000073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$69.32 |
| Max. Negotiated Rate |
$264.26 |
| Rate for Payer: Anthem Medicaid |
$69.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$264.26
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Humana Medicaid |
$69.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.71
|
| Rate for Payer: Molina Healthcare Passport |
$69.32
|
| Rate for Payer: Multiplan PHCS |
$158.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.98
|
| Rate for Payer: UHCCP Medicaid |
$92.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.01
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
IP
|
$264.26
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
47000073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$253.69 |
| Rate for Payer: Aetna Commercial |
$203.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$206.12
|
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Cigna Commercial |
$219.34
|
| Rate for Payer: First Health Commercial |
$251.05
|
| Rate for Payer: Humana Commercial |
$224.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$216.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$195.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$232.55
|
| Rate for Payer: Ohio Health Group HMO |
$198.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.92
|
| Rate for Payer: PHCS Commercial |
$253.69
|
| Rate for Payer: United Healthcare All Payer |
$232.55
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
470T0073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.41 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$53.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Humana KY Medicaid |
$53.99
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$54.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.67
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Professional
|
Both
|
$107.26
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
470P0073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.54 |
| Max. Negotiated Rate |
$107.26 |
| Rate for Payer: Anthem Medicaid |
$69.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.26
|
| Rate for Payer: Cash Price |
$53.63
|
| Rate for Payer: Cash Price |
$53.63
|
| Rate for Payer: Humana Medicaid |
$69.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.71
|
| Rate for Payer: Molina Healthcare Passport |
$69.32
|
| Rate for Payer: Multiplan PHCS |
$64.36
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.08
|
| Rate for Payer: UHCCP Medicaid |
$37.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.01
|
|
