|
FEMORAL COMP PFC SIG SZ 2 L
|
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 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 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 4 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
|
|
|
FEMORAL COMP PFC SIG SZ 4 L
|
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 4 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 4 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 5 L
|
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 5 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
|
|
|
FEMORAL COMP PFC SIG SZ 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 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 6 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
|
|
|
FEMORAL COMP PFC SIG SZ 6 L
|
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 6 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 6 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 CPS SEG OSS TPR 10CM L
|
Facility
|
IP
|
$77,311.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,193.48 |
| Max. Negotiated Rate |
$74,219.14 |
| Rate for Payer: Aetna Commercial |
$59,529.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,303.05
|
| Rate for Payer: Cash Price |
$38,655.80
|
| Rate for Payer: Cigna Commercial |
$64,168.63
|
| Rate for Payer: First Health Commercial |
$73,446.02
|
| Rate for Payer: Humana Commercial |
$65,714.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,395.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,055.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,193.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,034.21
|
| Rate for Payer: Ohio Health Group HMO |
$57,983.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,849.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,261.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,345.00
|
| Rate for Payer: PHCS Commercial |
$74,219.14
|
| Rate for Payer: United Healthcare All Payer |
$68,034.21
|
|
|
FEMORAL CPS SEG OSS TPR 10CM L
|
Facility
|
OP
|
$77,311.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,193.48 |
| Max. Negotiated Rate |
$74,219.14 |
| Rate for Payer: Aetna Commercial |
$59,529.93
|
| Rate for Payer: Anthem Medicaid |
$26,587.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,303.05
|
| Rate for Payer: Cash Price |
$38,655.80
|
| Rate for Payer: Cigna Commercial |
$64,168.63
|
| Rate for Payer: First Health Commercial |
$73,446.02
|
| Rate for Payer: Humana Commercial |
$65,714.86
|
| Rate for Payer: Humana KY Medicaid |
$26,587.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26,858.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,395.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,055.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,193.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,120.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,034.21
|
| Rate for Payer: Ohio Health Group HMO |
$57,983.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,849.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,261.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,345.00
|
| Rate for Payer: PHCS Commercial |
$74,219.14
|
| Rate for Payer: United Healthcare All Payer |
$68,034.21
|
|
|
FEMORAL CPS SEG OSS TPR 10CM R
|
Facility
|
IP
|
$77,311.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,193.48 |
| Max. Negotiated Rate |
$74,219.14 |
| Rate for Payer: Aetna Commercial |
$59,529.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,303.05
|
| Rate for Payer: Cash Price |
$38,655.80
|
| Rate for Payer: Cigna Commercial |
$64,168.63
|
| Rate for Payer: First Health Commercial |
$73,446.02
|
| Rate for Payer: Humana Commercial |
$65,714.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,395.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,055.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,193.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,034.21
|
| Rate for Payer: Ohio Health Group HMO |
$57,983.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,849.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,261.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,345.00
|
| Rate for Payer: PHCS Commercial |
$74,219.14
|
| Rate for Payer: United Healthcare All Payer |
$68,034.21
|
|
|
FEMORAL CPS SEG OSS TPR 10CM R
|
Facility
|
OP
|
$77,311.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,193.48 |
| Max. Negotiated Rate |
$74,219.14 |
| Rate for Payer: Aetna Commercial |
$59,529.93
|
| Rate for Payer: Anthem Medicaid |
$26,587.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,303.05
|
| Rate for Payer: Cash Price |
$38,655.80
|
| Rate for Payer: Cigna Commercial |
$64,168.63
|
| Rate for Payer: First Health Commercial |
$73,446.02
|
| Rate for Payer: Humana Commercial |
$65,714.86
|
| Rate for Payer: Humana KY Medicaid |
$26,587.46
|
| Rate for Payer: Kentucky WC Medicaid |
$26,858.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,395.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,055.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,193.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,120.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,034.21
|
| Rate for Payer: Ohio Health Group HMO |
$57,983.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,849.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,261.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,345.00
|
| Rate for Payer: PHCS Commercial |
$74,219.14
|
| Rate for Payer: United Healthcare All Payer |
$68,034.21
|
|
|
FEMORAL CPS SEG OSS TPR 7CM L
|
Facility
|
OP
|
$72,797.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,839.16 |
| Max. Negotiated Rate |
$69,885.31 |
| Rate for Payer: Aetna Commercial |
$56,053.84
|
| Rate for Payer: Anthem Medicaid |
$25,034.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,781.82
|
| Rate for Payer: Cash Price |
$36,398.60
|
| Rate for Payer: Cigna Commercial |
$60,421.68
|
| Rate for Payer: First Health Commercial |
$69,157.34
|
| Rate for Payer: Humana Commercial |
$61,877.62
|
| Rate for Payer: Humana KY Medicaid |
$25,034.96
|
| Rate for Payer: Kentucky WC Medicaid |
$25,289.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,693.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,724.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,839.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,537.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,061.54
|
| Rate for Payer: Ohio Health Group HMO |
$54,597.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,237.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,230.07
|
| Rate for Payer: PHCS Commercial |
$69,885.31
|
| Rate for Payer: United Healthcare All Payer |
$64,061.54
|
|
|
FEMORAL CPS SEG OSS TPR 7CM L
|
Facility
|
IP
|
$72,797.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,839.16 |
| Max. Negotiated Rate |
$69,885.31 |
| Rate for Payer: Aetna Commercial |
$56,053.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,781.82
|
| Rate for Payer: Cash Price |
$36,398.60
|
| Rate for Payer: Cigna Commercial |
$60,421.68
|
| Rate for Payer: First Health Commercial |
$69,157.34
|
| Rate for Payer: Humana Commercial |
$61,877.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,693.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,724.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,839.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,061.54
|
| Rate for Payer: Ohio Health Group HMO |
$54,597.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,237.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,230.07
|
| Rate for Payer: PHCS Commercial |
$69,885.31
|
| Rate for Payer: United Healthcare All Payer |
$64,061.54
|
|
|
FEMORAL CPS SEG OSS TPR 7CM R
|
Facility
|
OP
|
$72,797.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,839.16 |
| Max. Negotiated Rate |
$69,885.31 |
| Rate for Payer: Aetna Commercial |
$56,053.84
|
| Rate for Payer: Anthem Medicaid |
$25,034.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,781.82
|
| Rate for Payer: Cash Price |
$36,398.60
|
| Rate for Payer: Cigna Commercial |
$60,421.68
|
| Rate for Payer: First Health Commercial |
$69,157.34
|
| Rate for Payer: Humana Commercial |
$61,877.62
|
| Rate for Payer: Humana KY Medicaid |
$25,034.96
|
| Rate for Payer: Kentucky WC Medicaid |
$25,289.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,693.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,724.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,839.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,537.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,061.54
|
| Rate for Payer: Ohio Health Group HMO |
$54,597.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,237.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,230.07
|
| Rate for Payer: PHCS Commercial |
$69,885.31
|
| Rate for Payer: United Healthcare All Payer |
$64,061.54
|
|
|
FEMORAL CPS SEG OSS TPR 7CM R
|
Facility
|
IP
|
$72,797.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,839.16 |
| Max. Negotiated Rate |
$69,885.31 |
| Rate for Payer: Aetna Commercial |
$56,053.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,781.82
|
| Rate for Payer: Cash Price |
$36,398.60
|
| Rate for Payer: Cigna Commercial |
$60,421.68
|
| Rate for Payer: First Health Commercial |
$69,157.34
|
| Rate for Payer: Humana Commercial |
$61,877.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,693.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,724.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,839.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,061.54
|
| Rate for Payer: Ohio Health Group HMO |
$54,597.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,237.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,230.07
|
| Rate for Payer: PHCS Commercial |
$69,885.31
|
| Rate for Payer: United Healthcare All Payer |
$64,061.54
|
|
|
FEMORAL DISTAL #5 8MM
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
FEMORAL DISTAL #5 8MM
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
