|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$9,207.66
|
|
|
Service Code
|
MSDRG 536
|
| Min. Negotiated Rate |
$6,248.06 |
| Max. Negotiated Rate |
$9,207.66 |
| Rate for Payer: Anthem Medicaid |
$6,248.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,576.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,207.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,878.82
|
| Rate for Payer: Humana KY Medicaid |
$6,248.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,576.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,310.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,892.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,373.02
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$17,789.46
|
|
|
Service Code
|
MSDRG 562
|
| Min. Negotiated Rate |
$12,071.42 |
| Max. Negotiated Rate |
$17,789.46 |
| Rate for Payer: Anthem Medicaid |
$12,071.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,706.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,789.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,154.13
|
| Rate for Payer: Humana KY Medicaid |
$12,071.42
|
| Rate for Payer: Humana Medicare Advantage |
$12,706.76
|
| Rate for Payer: Kentucky WC Medicaid |
$12,192.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,248.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,312.85
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
|
IP
|
$10,476.93
|
|
|
Service Code
|
MSDRG 563
|
| Min. Negotiated Rate |
$7,109.34 |
| Max. Negotiated Rate |
$10,476.93 |
| Rate for Payer: Anthem Medicaid |
$7,109.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,483.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,476.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,102.75
|
| Rate for Payer: Humana KY Medicaid |
$7,109.34
|
| Rate for Payer: Humana Medicare Advantage |
$7,483.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,180.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,980.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,251.53
|
|
|
FRAGILE X GENE DETECTION
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS 81243
|
| Hospital Charge Code |
30000189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$354.20
|
| Rate for Payer: Anthem Medicaid |
$57.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$57.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$79.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.04
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: First Health Commercial |
$437.00
|
| Rate for Payer: Humana Commercial |
$391.00
|
| Rate for Payer: Humana KY Medicaid |
$57.04
|
| Rate for Payer: Humana Medicare Advantage |
$57.04
|
| Rate for Payer: Kentucky WC Medicaid |
$57.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$377.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$339.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$404.80
|
| Rate for Payer: Ohio Health Group HMO |
$345.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.60
|
| Rate for Payer: PHCS Commercial |
$441.60
|
| Rate for Payer: United Healthcare All Payer |
$404.80
|
|
|
FRAGILE X GENE DETECTION
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS 81243
|
| Hospital Charge Code |
30000189
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$354.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.38
|
| Rate for Payer: Cash Price |
$230.00
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: First Health Commercial |
$437.00
|
| Rate for Payer: Humana Commercial |
$391.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$377.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$339.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$404.80
|
| Rate for Payer: Ohio Health Group HMO |
$345.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.60
|
| Rate for Payer: PHCS Commercial |
$441.60
|
| Rate for Payer: United Healthcare All Payer |
$404.80
|
|
|
FRAGMIN 2500UN (10000UN/1ML)
|
Facility
|
IP
|
$537.79
|
|
|
Service Code
|
HCPCS J1645
|
| Hospital Charge Code |
25003812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$516.28 |
| Rate for Payer: Aetna Commercial |
$414.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$419.48
|
| Rate for Payer: Cash Price |
$268.90
|
| Rate for Payer: Cigna Commercial |
$446.37
|
| Rate for Payer: First Health Commercial |
$510.90
|
| Rate for Payer: Humana Commercial |
$457.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$473.26
|
| Rate for Payer: Ohio Health Group HMO |
$403.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.71
|
| Rate for Payer: PHCS Commercial |
$516.28
|
| Rate for Payer: United Healthcare All Payer |
$473.26
|
|
|
FRAGMIN 2500UN (10000UN/1ML)
|
Facility
|
OP
|
$537.79
|
|
|
Service Code
|
HCPCS J1645
|
| Hospital Charge Code |
25003812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$516.28 |
| Rate for Payer: Aetna Commercial |
$414.10
|
| Rate for Payer: Anthem Medicaid |
$184.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$419.48
|
| Rate for Payer: Cash Price |
$268.90
|
| Rate for Payer: Cigna Commercial |
$446.37
|
| Rate for Payer: First Health Commercial |
$510.90
|
| Rate for Payer: Humana Commercial |
$457.12
|
| Rate for Payer: Humana KY Medicaid |
$184.95
|
| Rate for Payer: Kentucky WC Medicaid |
$186.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$473.26
|
| Rate for Payer: Ohio Health Group HMO |
$403.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.71
|
| Rate for Payer: PHCS Commercial |
$516.28
|
| Rate for Payer: United Healthcare All Payer |
$473.26
|
|
|
FRAME ASSEMBLED FOOT 180MM
|
Facility
|
OP
|
$26,105.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,393.66 |
| Max. Negotiated Rate |
$25,060.85 |
| Rate for Payer: Aetna Commercial |
$20,100.89
|
| Rate for Payer: Anthem Medicaid |
$8,977.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,361.94
|
| Rate for Payer: Cash Price |
$13,052.52
|
| Rate for Payer: Cigna Commercial |
$21,667.19
|
| Rate for Payer: First Health Commercial |
$24,799.80
|
| Rate for Payer: Humana Commercial |
$22,189.29
|
| Rate for Payer: Humana KY Medicaid |
$8,977.53
|
| Rate for Payer: Kentucky WC Medicaid |
$9,068.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,406.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,265.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,831.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,157.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,972.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,578.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,221.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,393.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,092.57
|
| Rate for Payer: PHCS Commercial |
$25,060.85
|
| Rate for Payer: United Healthcare All Payer |
$22,972.44
|
|
|
FRAME ASSEMBLED FOOT 180MM
|
Facility
|
IP
|
$26,105.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,393.66 |
| Max. Negotiated Rate |
$25,060.85 |
| Rate for Payer: Aetna Commercial |
$20,100.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,361.94
|
| Rate for Payer: Cash Price |
$13,052.52
|
| Rate for Payer: Cigna Commercial |
$21,667.19
|
| Rate for Payer: First Health Commercial |
$24,799.80
|
| Rate for Payer: Humana Commercial |
$22,189.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,406.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,265.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,831.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,972.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,578.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,221.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,393.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,092.57
|
| Rate for Payer: PHCS Commercial |
$25,060.85
|
| Rate for Payer: United Healthcare All Payer |
$22,972.44
|
|
|
FREEDOM ALL POLY CUP 50MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 50MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 52MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 52MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 54MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 54MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 56MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 56MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 58MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 58MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 60MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 60MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 62MM
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM ALL POLY CUP 62MM
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
FREEDOM CONSTR HD 36MM TI STD
|
Facility
|
OP
|
$10,816.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.09 |
| Max. Negotiated Rate |
$10,383.44 |
| Rate for Payer: Aetna Commercial |
$8,328.38
|
| Rate for Payer: Anthem Medicaid |
$3,719.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,436.54
|
| Rate for Payer: Cash Price |
$5,408.04
|
| Rate for Payer: Cigna Commercial |
$8,977.35
|
| Rate for Payer: First Health Commercial |
$10,275.28
|
| Rate for Payer: Humana Commercial |
$9,193.67
|
| Rate for Payer: Humana KY Medicaid |
$3,719.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,757.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,869.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,982.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,794.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,518.15
|
| Rate for Payer: Ohio Health Group HMO |
$8,112.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,163.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,406.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,352.98
|
| Rate for Payer: PHCS Commercial |
$10,383.44
|
| Rate for Payer: United Healthcare All Payer |
$9,518.15
|
|
|
FREEDOM CONSTR HD 36MM TI STD
|
Facility
|
IP
|
$10,816.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.09 |
| Max. Negotiated Rate |
$10,383.44 |
| Rate for Payer: Aetna Commercial |
$8,328.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,436.54
|
| Rate for Payer: Cash Price |
$5,408.04
|
| Rate for Payer: Cigna Commercial |
$8,977.35
|
| Rate for Payer: First Health Commercial |
$10,275.28
|
| Rate for Payer: Humana Commercial |
$9,193.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,869.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,982.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,518.15
|
| Rate for Payer: Ohio Health Group HMO |
$8,112.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,163.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,406.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,352.98
|
| Rate for Payer: PHCS Commercial |
$10,383.44
|
| Rate for Payer: United Healthcare All Payer |
$9,518.15
|
|
