|
FEM NONPOROUS GII PS SZ7 RT
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM NONPOROUS GII PS SZ 8 LT
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM NONPOROUS GII PS SZ 8 LT
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM NONPOROUS GII PS SZ8 RT
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM NONPOROUS GII PS SZ8 RT
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEMORAL ARTERIOGRAM
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
32000383
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$575.90 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,373.30
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
FEMORAL ARTERIOGRAM
|
Facility
|
OP
|
$4,430.00
|
|
|
Service Code
|
HCPCS 75716
|
| Hospital Charge Code |
32000383
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$575.90 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem Medicaid |
$1,523.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Humana KY Medicaid |
$1,523.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,373.30
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
FEMORAL ASTEM 12MMX140MM
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
FEMORAL ASTEM 12MMX140MM
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
FEMORAL BUSHING OSS POLY 2PK
|
Facility
|
IP
|
$4,359.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.69 |
| Max. Negotiated Rate |
$4,184.78 |
| Rate for Payer: Aetna Commercial |
$3,356.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,400.14
|
| Rate for Payer: Cash Price |
$2,179.57
|
| Rate for Payer: Cigna Commercial |
$3,618.09
|
| Rate for Payer: First Health Commercial |
$4,141.19
|
| Rate for Payer: Humana Commercial |
$3,705.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,574.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,217.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,836.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,269.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.34
|
| Rate for Payer: PHCS Commercial |
$4,184.78
|
| Rate for Payer: United Healthcare All Payer |
$3,836.05
|
|
|
FEMORAL BUSHING OSS POLY 2PK
|
Facility
|
OP
|
$4,359.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.69 |
| Max. Negotiated Rate |
$4,184.78 |
| Rate for Payer: Aetna Commercial |
$3,356.55
|
| Rate for Payer: Anthem Medicaid |
$1,499.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,400.14
|
| Rate for Payer: Cash Price |
$2,179.57
|
| Rate for Payer: Cigna Commercial |
$3,618.09
|
| Rate for Payer: First Health Commercial |
$4,141.19
|
| Rate for Payer: Humana Commercial |
$3,705.28
|
| Rate for Payer: Humana KY Medicaid |
$1,499.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,514.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,574.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,217.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,836.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,269.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.34
|
| Rate for Payer: PHCS Commercial |
$4,184.78
|
| Rate for Payer: United Healthcare All Payer |
$3,836.05
|
|
|
FEMORAL CENTERING SLEEVE 11MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 11MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 13MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 13MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 15MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 15MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 17MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 17MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 7MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 7MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 8MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 8MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 9MM
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
FEMORAL CENTERING SLEEVE 9MM
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
