|
FEMORAL COMP 8*120MM 162900
|
Facility
|
IP
|
$8,559.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.76 |
| Max. Negotiated Rate |
$8,217.31 |
| Rate for Payer: Aetna Commercial |
$6,590.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,676.57
|
| Rate for Payer: Cash Price |
$4,279.85
|
| Rate for Payer: Cigna Commercial |
$7,104.55
|
| Rate for Payer: First Health Commercial |
$8,131.72
|
| Rate for Payer: Humana Commercial |
$7,275.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,018.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,317.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,532.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,419.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,711.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,653.51
|
| Rate for Payer: PHCS Commercial |
$8,217.31
|
| Rate for Payer: United Healthcare All Payer |
$7,532.54
|
|
|
FEMORAL COMP 8*120MM 162900
|
Facility
|
OP
|
$8,559.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.76 |
| Max. Negotiated Rate |
$8,217.31 |
| Rate for Payer: Aetna Commercial |
$6,590.97
|
| Rate for Payer: Anthem Medicaid |
$2,943.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,676.57
|
| Rate for Payer: Cash Price |
$4,279.85
|
| Rate for Payer: Cigna Commercial |
$7,104.55
|
| Rate for Payer: First Health Commercial |
$8,131.72
|
| Rate for Payer: Humana Commercial |
$7,275.74
|
| Rate for Payer: Humana KY Medicaid |
$2,943.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,973.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,018.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,317.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,002.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,532.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,419.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,711.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,653.51
|
| Rate for Payer: PHCS Commercial |
$8,217.31
|
| Rate for Payer: United Healthcare All Payer |
$7,532.54
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 L
|
Facility
|
IP
|
$12,452.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.81 |
| Max. Negotiated Rate |
$11,954.28 |
| Rate for Payer: Aetna Commercial |
$9,588.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,712.86
|
| Rate for Payer: Cash Price |
$6,226.19
|
| Rate for Payer: Cigna Commercial |
$10,335.48
|
| Rate for Payer: First Health Commercial |
$11,829.76
|
| Rate for Payer: Humana Commercial |
$10,584.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,210.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,189.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,735.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,958.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,339.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,490.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,860.24
|
| Rate for Payer: PHCS Commercial |
$11,954.28
|
| Rate for Payer: United Healthcare All Payer |
$10,958.09
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 L
|
Facility
|
OP
|
$12,452.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.81 |
| Max. Negotiated Rate |
$11,954.28 |
| Rate for Payer: Aetna Commercial |
$9,588.33
|
| Rate for Payer: Anthem Medicaid |
$4,282.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,712.86
|
| Rate for Payer: Cash Price |
$6,226.19
|
| Rate for Payer: Cigna Commercial |
$10,335.48
|
| Rate for Payer: First Health Commercial |
$11,829.76
|
| Rate for Payer: Humana Commercial |
$10,584.52
|
| Rate for Payer: Humana KY Medicaid |
$4,282.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,325.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,210.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,189.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,735.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,368.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,958.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,339.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,490.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,860.24
|
| Rate for Payer: PHCS Commercial |
$11,954.28
|
| Rate for Payer: United Healthcare All Payer |
$10,958.09
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 R
|
Facility
|
OP
|
$12,452.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.81 |
| Max. Negotiated Rate |
$11,954.28 |
| Rate for Payer: Aetna Commercial |
$9,588.33
|
| Rate for Payer: Anthem Medicaid |
$4,282.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,712.86
|
| Rate for Payer: Cash Price |
$6,226.19
|
| Rate for Payer: Cigna Commercial |
$10,335.48
|
| Rate for Payer: First Health Commercial |
$11,829.76
|
| Rate for Payer: Humana Commercial |
$10,584.52
|
| Rate for Payer: Humana KY Medicaid |
$4,282.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,325.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,210.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,189.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,735.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,368.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,958.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,339.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,490.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,860.24
|
| Rate for Payer: PHCS Commercial |
$11,954.28
|
| Rate for Payer: United Healthcare All Payer |
$10,958.09
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 R
|
Facility
|
IP
|
$12,452.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.81 |
| Max. Negotiated Rate |
$11,954.28 |
| Rate for Payer: Aetna Commercial |
$9,588.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,712.86
|
| Rate for Payer: Cash Price |
$6,226.19
|
| Rate for Payer: Cigna Commercial |
$10,335.48
|
| Rate for Payer: First Health Commercial |
$11,829.76
|
| Rate for Payer: Humana Commercial |
$10,584.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,210.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,189.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,735.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,958.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,339.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,490.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,860.24
|
| Rate for Payer: PHCS Commercial |
$11,954.28
|
| Rate for Payer: United Healthcare All Payer |
$10,958.09
|
|
|
FEMORAL COMP PFC SIG SZ 2.5 R
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 2.5 R
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 2 L
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 2 L
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 2 R
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 2 R
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 4 L
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 4 L
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 4 R
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 4 R
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 5 L
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 5 L
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 5 R
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 5 R
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 6 L
|
Facility
|
OP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem Medicaid |
$4,671.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Humana KY Medicaid |
$4,671.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,718.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 6 L
|
Facility
|
IP
|
$13,583.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,765.87 |
| Max. Negotiated Rate |
$13,040.24 |
| Rate for Payer: Aetna Commercial |
$10,459.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,595.19
|
| Rate for Payer: Cash Price |
$6,791.79
|
| Rate for Payer: Cigna Commercial |
$11,274.37
|
| Rate for Payer: First Health Commercial |
$12,904.40
|
| Rate for Payer: Humana Commercial |
$11,546.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,138.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,024.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,953.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,187.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,716.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,210.91
|
| Rate for Payer: PHCS Commercial |
$13,040.24
|
| Rate for Payer: United Healthcare All Payer |
$11,953.55
|
|
|
FEMORAL COMP PFC SIG SZ 6 R
|
Facility
|
OP
|
$12,452.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.81 |
| Max. Negotiated Rate |
$11,954.28 |
| Rate for Payer: Aetna Commercial |
$9,588.33
|
| Rate for Payer: Anthem Medicaid |
$4,282.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,712.86
|
| Rate for Payer: Cash Price |
$6,226.19
|
| Rate for Payer: Cigna Commercial |
$10,335.48
|
| Rate for Payer: First Health Commercial |
$11,829.76
|
| Rate for Payer: Humana Commercial |
$10,584.52
|
| Rate for Payer: Humana KY Medicaid |
$4,282.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,325.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,210.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,189.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,735.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,368.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,958.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,339.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,490.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,860.24
|
| Rate for Payer: PHCS Commercial |
$11,954.28
|
| Rate for Payer: United Healthcare All Payer |
$10,958.09
|
|
|
FEMORAL COMP PFC SIG SZ 6 R
|
Facility
|
IP
|
$12,452.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,618.81 |
| Max. Negotiated Rate |
$11,954.28 |
| Rate for Payer: Aetna Commercial |
$9,588.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,712.86
|
| Rate for Payer: Cash Price |
$6,226.19
|
| Rate for Payer: Cigna Commercial |
$10,335.48
|
| Rate for Payer: First Health Commercial |
$11,829.76
|
| Rate for Payer: Humana Commercial |
$10,584.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,210.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,189.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,735.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,958.09
|
| Rate for Payer: Ohio Health Group HMO |
$9,339.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,490.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,860.24
|
| Rate for Payer: PHCS Commercial |
$11,954.28
|
| Rate for Payer: United Healthcare All Payer |
$10,958.09
|
|
|
FEMORAL CPS SEG OSS TPR 10CM L
|
Facility
|
IP
|
$74,795.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,723.38 |
| Max. Negotiated Rate |
$71,803.39 |
| Rate for Payer: Aetna Commercial |
$57,592.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,340.26
|
| Rate for Payer: Cash Price |
$37,397.60
|
| Rate for Payer: Cigna Commercial |
$62,080.02
|
| Rate for Payer: First Health Commercial |
$71,055.44
|
| Rate for Payer: Humana Commercial |
$63,575.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,332.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,198.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,438.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,819.78
|
| Rate for Payer: Ohio Health Group HMO |
$56,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,959.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,723.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,186.51
|
| Rate for Payer: PHCS Commercial |
$71,803.39
|
| Rate for Payer: United Healthcare All Payer |
$65,819.78
|
|
