|
DISPENS FEE HEAR-AID CROS
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS V5240
|
| Hospital Charge Code |
27000234
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem Medicaid |
$92.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.82
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Humana KY Medicaid |
$92.51
|
| Rate for Payer: Kentucky WC Medicaid |
$93.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
DISPENS FEE HEAR-AID CROS
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS V5240
|
| Hospital Charge Code |
27000234
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.82
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
DISPENS FEE HEAR-AID CROS
|
Professional
|
Both
|
$269.00
|
|
| Hospital Charge Code |
27000234
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$188.30 |
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Multiplan PHCS |
$161.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.30
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
|
|
DISPENS FEE MONAURAL
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS V5241
|
| Hospital Charge Code |
27000235
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.82
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
DISPENS FEE MONAURAL
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS V5241
|
| Hospital Charge Code |
27000235
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$80.70 |
| Max. Negotiated Rate |
$258.24 |
| Rate for Payer: Aetna Commercial |
$207.13
|
| Rate for Payer: Anthem Medicaid |
$92.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.82
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: Cigna Commercial |
$223.27
|
| Rate for Payer: First Health Commercial |
$255.55
|
| Rate for Payer: Humana Commercial |
$228.65
|
| Rate for Payer: Humana KY Medicaid |
$92.51
|
| Rate for Payer: Kentucky WC Medicaid |
$93.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$220.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$198.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$236.72
|
| Rate for Payer: Ohio Health Group HMO |
$201.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.61
|
| Rate for Payer: PHCS Commercial |
$258.24
|
| Rate for Payer: United Healthcare All Payer |
$236.72
|
|
|
DISPOSABLE KIT FOR DX KNOTLESS
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
DISPOSABLE KIT FOR DX KNOTLESS
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
DISPOSABLE KIT NANO SWIVELOCK
|
Facility
|
OP
|
$3,106.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem Medicaid |
$1,068.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Humana KY Medicaid |
$1,068.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,079.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
DISPOSABLE KIT NANO SWIVELOCK
|
Facility
|
IP
|
$3,106.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
DISSECTION, DEEP JUGULAR NODE(S)
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 38542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
DISTAL BICEPS REPAIR IMP SYS
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
DISTAL BICEPS REPAIR IMP SYS
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
DISTAL FEM AXIAL PIN ONE SIZE
|
Facility
|
IP
|
$13,720.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,116.28 |
| Max. Negotiated Rate |
$13,172.11 |
| Rate for Payer: Aetna Commercial |
$10,565.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,702.34
|
| Rate for Payer: Cash Price |
$6,860.48
|
| Rate for Payer: Cigna Commercial |
$11,388.39
|
| Rate for Payer: First Health Commercial |
$13,034.90
|
| Rate for Payer: Humana Commercial |
$11,662.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,251.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,126.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,116.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,074.44
|
| Rate for Payer: Ohio Health Group HMO |
$10,290.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,976.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,937.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,467.46
|
| Rate for Payer: PHCS Commercial |
$13,172.11
|
| Rate for Payer: United Healthcare All Payer |
$12,074.44
|
|
|
DISTAL FEM AXIAL PIN ONE SIZE
|
Facility
|
OP
|
$13,720.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,116.28 |
| Max. Negotiated Rate |
$13,172.11 |
| Rate for Payer: Aetna Commercial |
$10,565.13
|
| Rate for Payer: Anthem Medicaid |
$4,718.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,702.34
|
| Rate for Payer: Cash Price |
$6,860.48
|
| Rate for Payer: Cigna Commercial |
$11,388.39
|
| Rate for Payer: First Health Commercial |
$13,034.90
|
| Rate for Payer: Humana Commercial |
$11,662.81
|
| Rate for Payer: Humana KY Medicaid |
$4,718.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,766.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,251.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,126.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,116.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,813.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,074.44
|
| Rate for Payer: Ohio Health Group HMO |
$10,290.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,976.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,937.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,467.46
|
| Rate for Payer: PHCS Commercial |
$13,172.11
|
| Rate for Payer: United Healthcare All Payer |
$12,074.44
|
|
|
DISTAL FEMORAL RIGHT #6 4MM
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
DISTAL FEMORAL RIGHT #6 4MM
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
DISTAL FEMUR SEG 65MM LT
|
Facility
|
IP
|
$37,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,141.25 |
| Max. Negotiated Rate |
$35,652.00 |
| Rate for Payer: Aetna Commercial |
$28,595.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,967.25
|
| Rate for Payer: Cash Price |
$18,568.75
|
| Rate for Payer: Cigna Commercial |
$30,824.12
|
| Rate for Payer: First Health Commercial |
$35,280.62
|
| Rate for Payer: Humana Commercial |
$31,566.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,452.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,407.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,141.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,681.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,853.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,309.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,624.88
|
| Rate for Payer: PHCS Commercial |
$35,652.00
|
| Rate for Payer: United Healthcare All Payer |
$32,681.00
|
|
|
DISTAL FEMUR SEG 65MM LT
|
Facility
|
OP
|
$37,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,141.25 |
| Max. Negotiated Rate |
$35,652.00 |
| Rate for Payer: Aetna Commercial |
$28,595.88
|
| Rate for Payer: Anthem Medicaid |
$12,771.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,967.25
|
| Rate for Payer: Cash Price |
$18,568.75
|
| Rate for Payer: Cigna Commercial |
$30,824.12
|
| Rate for Payer: First Health Commercial |
$35,280.62
|
| Rate for Payer: Humana Commercial |
$31,566.88
|
| Rate for Payer: Humana KY Medicaid |
$12,771.59
|
| Rate for Payer: Kentucky WC Medicaid |
$12,901.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,452.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,407.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,141.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,027.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,681.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,853.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,309.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,624.88
|
| Rate for Payer: PHCS Commercial |
$35,652.00
|
| Rate for Payer: United Healthcare All Payer |
$32,681.00
|
|
|
DIST FEM AUG BLOCK #11/10MM
|
Facility
|
IP
|
$4,901.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.30 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,920.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.69
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
DIST FEM AUG BLOCK #11/10MM
|
Facility
|
OP
|
$4,901.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.30 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem Medicaid |
$1,685.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Humana KY Medicaid |
$1,685.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,920.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.69
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
DIST FEM AUG BLOCK #11/15MM
|
Facility
|
IP
|
$4,901.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.30 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,920.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.69
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
DIST FEM AUG BLOCK #11/15MM
|
Facility
|
OP
|
$4,901.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.30 |
| Max. Negotiated Rate |
$4,704.96 |
| Rate for Payer: Aetna Commercial |
$3,773.77
|
| Rate for Payer: Anthem Medicaid |
$1,685.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.78
|
| Rate for Payer: Cash Price |
$2,450.50
|
| Rate for Payer: Cigna Commercial |
$4,067.83
|
| Rate for Payer: First Health Commercial |
$4,655.95
|
| Rate for Payer: Humana Commercial |
$4,165.85
|
| Rate for Payer: Humana KY Medicaid |
$1,685.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,920.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.69
|
| Rate for Payer: PHCS Commercial |
$4,704.96
|
| Rate for Payer: United Healthcare All Payer |
$4,312.88
|
|
|
DIST FEM AUG BLOCK #11/5MM
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem Medicaid |
$1,932.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Humana KY Medicaid |
$1,932.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
DIST FEM AUG BLOCK #11/5MM
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
DIST FEM AUG BLOCK #13/05MM
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
