|
FEMORAL BUSHING OSS POLY 2PK
|
Facility
|
IP
|
$4,313.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.01 |
| Max. Negotiated Rate |
$4,140.84 |
| Rate for Payer: Aetna Commercial |
$3,321.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.44
|
| Rate for Payer: Cash Price |
$2,156.69
|
| Rate for Payer: Cigna Commercial |
$3,580.11
|
| Rate for Payer: First Health Commercial |
$4,097.71
|
| Rate for Payer: Humana Commercial |
$3,666.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,536.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,795.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,450.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,752.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,976.23
|
| Rate for Payer: PHCS Commercial |
$4,140.84
|
| Rate for Payer: United Healthcare All Payer |
$3,795.77
|
|
|
FEMORAL BUSHING OSS POLY 2PK
|
Facility
|
OP
|
$4,313.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.01 |
| Max. Negotiated Rate |
$4,140.84 |
| Rate for Payer: Aetna Commercial |
$3,321.30
|
| Rate for Payer: Anthem Medicaid |
$1,483.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.44
|
| Rate for Payer: Cash Price |
$2,156.69
|
| Rate for Payer: Cigna Commercial |
$3,580.11
|
| Rate for Payer: First Health Commercial |
$4,097.71
|
| Rate for Payer: Humana Commercial |
$3,666.37
|
| Rate for Payer: Humana KY Medicaid |
$1,483.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,498.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,536.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,795.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,450.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,752.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,976.23
|
| Rate for Payer: PHCS Commercial |
$4,140.84
|
| Rate for Payer: United Healthcare All Payer |
$3,795.77
|
|
|
FEMORAL CENTERING SLEEVE 11MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 11MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 13MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 13MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 15MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 15MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 17MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 17MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 7MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 7MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 8MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 8MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 9MM
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL CENTERING SLEEVE 9MM
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
FEMORAL COMP 8*120MM 162900
|
Facility
|
IP
|
$8,759.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,627.91 |
| Max. Negotiated Rate |
$8,409.31 |
| Rate for Payer: Aetna Commercial |
$6,744.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,832.57
|
| Rate for Payer: Cash Price |
$4,379.85
|
| Rate for Payer: Cigna Commercial |
$7,270.55
|
| Rate for Payer: First Health Commercial |
$8,321.72
|
| Rate for Payer: Humana Commercial |
$7,445.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,182.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,464.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,708.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,569.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,007.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,620.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,044.19
|
| Rate for Payer: PHCS Commercial |
$8,409.31
|
| Rate for Payer: United Healthcare All Payer |
$7,708.54
|
|
|
FEMORAL COMP 8*120MM 162900
|
Facility
|
OP
|
$8,759.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,627.91 |
| Max. Negotiated Rate |
$8,409.31 |
| Rate for Payer: Aetna Commercial |
$6,744.97
|
| Rate for Payer: Anthem Medicaid |
$3,012.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,832.57
|
| Rate for Payer: Cash Price |
$4,379.85
|
| Rate for Payer: Cigna Commercial |
$7,270.55
|
| Rate for Payer: First Health Commercial |
$8,321.72
|
| Rate for Payer: Humana Commercial |
$7,445.74
|
| Rate for Payer: Humana KY Medicaid |
$3,012.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,043.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,182.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,464.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,072.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,708.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,569.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,007.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,620.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,044.19
|
| Rate for Payer: PHCS Commercial |
$8,409.31
|
| Rate for Payer: United Healthcare All Payer |
$7,708.54
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 L
|
Facility
|
OP
|
$12,702.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,810.76 |
| Max. Negotiated Rate |
$12,194.42 |
| Rate for Payer: Aetna Commercial |
$9,780.94
|
| Rate for Payer: Anthem Medicaid |
$4,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,907.97
|
| Rate for Payer: Cash Price |
$6,351.26
|
| Rate for Payer: Cigna Commercial |
$10,543.09
|
| Rate for Payer: First Health Commercial |
$12,067.39
|
| Rate for Payer: Humana Commercial |
$10,797.14
|
| Rate for Payer: Humana KY Medicaid |
$4,368.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,412.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,374.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,810.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,178.22
|
| Rate for Payer: Ohio Health Group HMO |
$9,526.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,162.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,051.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,764.74
|
| Rate for Payer: PHCS Commercial |
$12,194.42
|
| Rate for Payer: United Healthcare All Payer |
$11,178.22
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 L
|
Facility
|
IP
|
$12,702.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,810.76 |
| Max. Negotiated Rate |
$12,194.42 |
| Rate for Payer: Aetna Commercial |
$9,780.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,907.97
|
| Rate for Payer: Cash Price |
$6,351.26
|
| Rate for Payer: Cigna Commercial |
$10,543.09
|
| Rate for Payer: First Health Commercial |
$12,067.39
|
| Rate for Payer: Humana Commercial |
$10,797.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,374.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,810.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,178.22
|
| Rate for Payer: Ohio Health Group HMO |
$9,526.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,162.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,051.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,764.74
|
| Rate for Payer: PHCS Commercial |
$12,194.42
|
| Rate for Payer: United Healthcare All Payer |
$11,178.22
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 R
|
Facility
|
IP
|
$12,702.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,810.76 |
| Max. Negotiated Rate |
$12,194.42 |
| Rate for Payer: Aetna Commercial |
$9,780.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,907.97
|
| Rate for Payer: Cash Price |
$6,351.26
|
| Rate for Payer: Cigna Commercial |
$10,543.09
|
| Rate for Payer: First Health Commercial |
$12,067.39
|
| Rate for Payer: Humana Commercial |
$10,797.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,374.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,810.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,178.22
|
| Rate for Payer: Ohio Health Group HMO |
$9,526.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,162.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,051.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,764.74
|
| Rate for Payer: PHCS Commercial |
$12,194.42
|
| Rate for Payer: United Healthcare All Payer |
$11,178.22
|
|
|
FEMORAL COMP PFC SIG SZ 1.5 R
|
Facility
|
OP
|
$12,702.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,810.76 |
| Max. Negotiated Rate |
$12,194.42 |
| Rate for Payer: Aetna Commercial |
$9,780.94
|
| Rate for Payer: Anthem Medicaid |
$4,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,907.97
|
| Rate for Payer: Cash Price |
$6,351.26
|
| Rate for Payer: Cigna Commercial |
$10,543.09
|
| Rate for Payer: First Health Commercial |
$12,067.39
|
| Rate for Payer: Humana Commercial |
$10,797.14
|
| Rate for Payer: Humana KY Medicaid |
$4,368.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,412.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,416.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,374.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,810.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,178.22
|
| Rate for Payer: Ohio Health Group HMO |
$9,526.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,162.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,051.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,764.74
|
| Rate for Payer: PHCS Commercial |
$12,194.42
|
| Rate for Payer: United Healthcare All Payer |
$11,178.22
|
|
|
FEMORAL COMP PFC SIG SZ 2.5 R
|
Facility
|
IP
|
$13,839.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,151.98 |
| Max. Negotiated Rate |
$13,286.33 |
| Rate for Payer: Aetna Commercial |
$10,656.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,795.15
|
| Rate for Payer: Cash Price |
$6,919.97
|
| Rate for Payer: Cigna Commercial |
$11,487.14
|
| Rate for Payer: First Health Commercial |
$13,147.93
|
| Rate for Payer: Humana Commercial |
$11,763.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,348.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,213.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,151.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,179.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,379.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,071.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,040.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,549.55
|
| Rate for Payer: PHCS Commercial |
$13,286.33
|
| Rate for Payer: United Healthcare All Payer |
$12,179.14
|
|
|
FEMORAL COMP PFC SIG SZ 2.5 R
|
Facility
|
OP
|
$13,839.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,151.98 |
| Max. Negotiated Rate |
$13,286.33 |
| Rate for Payer: Aetna Commercial |
$10,656.75
|
| Rate for Payer: Anthem Medicaid |
$4,759.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,795.15
|
| Rate for Payer: Cash Price |
$6,919.97
|
| Rate for Payer: Cigna Commercial |
$11,487.14
|
| Rate for Payer: First Health Commercial |
$13,147.93
|
| Rate for Payer: Humana Commercial |
$11,763.94
|
| Rate for Payer: Humana KY Medicaid |
$4,759.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,807.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,348.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,213.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,151.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,855.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,179.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,379.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,071.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,040.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,549.55
|
| Rate for Payer: PHCS Commercial |
$13,286.33
|
| Rate for Payer: United Healthcare All Payer |
$12,179.14
|
|
|
FEMORAL COMP PFC SIG SZ 2 L
|
Facility
|
OP
|
$13,839.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,151.98 |
| Max. Negotiated Rate |
$13,286.33 |
| Rate for Payer: Aetna Commercial |
$10,656.75
|
| Rate for Payer: Anthem Medicaid |
$4,759.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,795.15
|
| Rate for Payer: Cash Price |
$6,919.97
|
| Rate for Payer: Cigna Commercial |
$11,487.14
|
| Rate for Payer: First Health Commercial |
$13,147.93
|
| Rate for Payer: Humana Commercial |
$11,763.94
|
| Rate for Payer: Humana KY Medicaid |
$4,759.55
|
| Rate for Payer: Kentucky WC Medicaid |
$4,807.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,348.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,213.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,151.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,855.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,179.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,379.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,071.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,040.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,549.55
|
| Rate for Payer: PHCS Commercial |
$13,286.33
|
| Rate for Payer: United Healthcare All Payer |
$12,179.14
|
|
