|
ANATOMICAL SHLDR PEG GLENOID L
|
Facility
|
IP
|
$8,717.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.21 |
| Max. Negotiated Rate |
$8,368.67 |
| Rate for Payer: Aetna Commercial |
$6,712.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,799.54
|
| Rate for Payer: Cash Price |
$4,358.68
|
| Rate for Payer: Cigna Commercial |
$7,235.41
|
| Rate for Payer: First Health Commercial |
$8,281.49
|
| Rate for Payer: Humana Commercial |
$7,409.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,148.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,433.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,671.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,538.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,973.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.98
|
| Rate for Payer: PHCS Commercial |
$8,368.67
|
| Rate for Payer: United Healthcare All Payer |
$7,671.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID L
|
Facility
|
OP
|
$8,717.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.21 |
| Max. Negotiated Rate |
$8,368.67 |
| Rate for Payer: Aetna Commercial |
$6,712.37
|
| Rate for Payer: Anthem Medicaid |
$2,997.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,799.54
|
| Rate for Payer: Cash Price |
$4,358.68
|
| Rate for Payer: Cigna Commercial |
$7,235.41
|
| Rate for Payer: First Health Commercial |
$8,281.49
|
| Rate for Payer: Humana Commercial |
$7,409.76
|
| Rate for Payer: Humana KY Medicaid |
$2,997.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,028.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,148.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,433.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,058.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,671.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,538.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,973.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.98
|
| Rate for Payer: PHCS Commercial |
$8,368.67
|
| Rate for Payer: United Healthcare All Payer |
$7,671.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID M
|
Facility
|
IP
|
$8,717.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.21 |
| Max. Negotiated Rate |
$8,368.67 |
| Rate for Payer: Aetna Commercial |
$6,712.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,799.54
|
| Rate for Payer: Cash Price |
$4,358.68
|
| Rate for Payer: Cigna Commercial |
$7,235.41
|
| Rate for Payer: First Health Commercial |
$8,281.49
|
| Rate for Payer: Humana Commercial |
$7,409.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,148.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,433.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,671.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,538.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,973.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.98
|
| Rate for Payer: PHCS Commercial |
$8,368.67
|
| Rate for Payer: United Healthcare All Payer |
$7,671.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID M
|
Facility
|
OP
|
$8,717.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.21 |
| Max. Negotiated Rate |
$8,368.67 |
| Rate for Payer: Aetna Commercial |
$6,712.37
|
| Rate for Payer: Anthem Medicaid |
$2,997.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,799.54
|
| Rate for Payer: Cash Price |
$4,358.68
|
| Rate for Payer: Cigna Commercial |
$7,235.41
|
| Rate for Payer: First Health Commercial |
$8,281.49
|
| Rate for Payer: Humana Commercial |
$7,409.76
|
| Rate for Payer: Humana KY Medicaid |
$2,997.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,028.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,148.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,433.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,058.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,671.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,538.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,973.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.98
|
| Rate for Payer: PHCS Commercial |
$8,368.67
|
| Rate for Payer: United Healthcare All Payer |
$7,671.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID S
|
Facility
|
IP
|
$8,717.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.21 |
| Max. Negotiated Rate |
$8,368.67 |
| Rate for Payer: Aetna Commercial |
$6,712.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,799.54
|
| Rate for Payer: Cash Price |
$4,358.68
|
| Rate for Payer: Cigna Commercial |
$7,235.41
|
| Rate for Payer: First Health Commercial |
$8,281.49
|
| Rate for Payer: Humana Commercial |
$7,409.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,148.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,433.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,671.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,538.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,973.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.98
|
| Rate for Payer: PHCS Commercial |
$8,368.67
|
| Rate for Payer: United Healthcare All Payer |
$7,671.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID S
|
Facility
|
OP
|
$8,717.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,615.21 |
| Max. Negotiated Rate |
$8,368.67 |
| Rate for Payer: Aetna Commercial |
$6,712.37
|
| Rate for Payer: Anthem Medicaid |
$2,997.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,799.54
|
| Rate for Payer: Cash Price |
$4,358.68
|
| Rate for Payer: Cigna Commercial |
$7,235.41
|
| Rate for Payer: First Health Commercial |
$8,281.49
|
| Rate for Payer: Humana Commercial |
$7,409.76
|
| Rate for Payer: Humana KY Medicaid |
$2,997.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,028.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,148.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,433.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,058.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,671.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,538.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,973.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.98
|
| Rate for Payer: PHCS Commercial |
$8,368.67
|
| Rate for Payer: United Healthcare All Payer |
$7,671.28
|
|
|
ANATOMICAL SHLDR PEG GLND MED.
|
Facility
|
IP
|
$8,303.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.03 |
| Max. Negotiated Rate |
$7,971.31 |
| Rate for Payer: Aetna Commercial |
$6,393.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,476.69
|
| Rate for Payer: Cash Price |
$4,151.73
|
| Rate for Payer: Cigna Commercial |
$6,891.86
|
| Rate for Payer: First Health Commercial |
$7,888.28
|
| Rate for Payer: Humana Commercial |
$7,057.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,808.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,307.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,227.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,642.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.38
|
| Rate for Payer: PHCS Commercial |
$7,971.31
|
| Rate for Payer: United Healthcare All Payer |
$7,307.04
|
|
|
ANATOMICAL SHLDR PEG GLND MED.
|
Facility
|
OP
|
$8,303.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.03 |
| Max. Negotiated Rate |
$7,971.31 |
| Rate for Payer: Aetna Commercial |
$6,393.66
|
| Rate for Payer: Anthem Medicaid |
$2,855.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,476.69
|
| Rate for Payer: Cash Price |
$4,151.73
|
| Rate for Payer: Cigna Commercial |
$6,891.86
|
| Rate for Payer: First Health Commercial |
$7,888.28
|
| Rate for Payer: Humana Commercial |
$7,057.93
|
| Rate for Payer: Humana KY Medicaid |
$2,855.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,884.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,808.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,912.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,307.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,227.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,642.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.38
|
| Rate for Payer: PHCS Commercial |
$7,971.31
|
| Rate for Payer: United Healthcare All Payer |
$7,307.04
|
|
|
ANATOMICAL SHLDR RMV HD 14*40
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 14*40
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 15*42
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 15*42
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 16*44
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 16*44
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 16*46
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 16*46
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 17*48
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 17*48
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 18*50
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 18*50
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 19*52
|
Facility
|
IP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHLDR RMV HD 19*52
|
Facility
|
OP
|
$11,089.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,326.87 |
| Max. Negotiated Rate |
$10,645.98 |
| Rate for Payer: Aetna Commercial |
$8,538.96
|
| Rate for Payer: Anthem Medicaid |
$3,813.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,649.86
|
| Rate for Payer: Cash Price |
$5,544.78
|
| Rate for Payer: Cigna Commercial |
$9,204.33
|
| Rate for Payer: First Health Commercial |
$10,535.08
|
| Rate for Payer: Humana Commercial |
$9,426.13
|
| Rate for Payer: Humana KY Medicaid |
$3,813.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,093.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,184.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,326.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,890.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,758.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,317.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,871.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,647.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,651.80
|
| Rate for Payer: PHCS Commercial |
$10,645.98
|
| Rate for Payer: United Healthcare All Payer |
$9,758.81
|
|
|
ANATOMICAL SHOLDR PEG GLND SM
|
Facility
|
OP
|
$8,303.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.03 |
| Max. Negotiated Rate |
$7,971.31 |
| Rate for Payer: Aetna Commercial |
$6,393.66
|
| Rate for Payer: Anthem Medicaid |
$2,855.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,476.69
|
| Rate for Payer: Cash Price |
$4,151.73
|
| Rate for Payer: Cigna Commercial |
$6,891.86
|
| Rate for Payer: First Health Commercial |
$7,888.28
|
| Rate for Payer: Humana Commercial |
$7,057.93
|
| Rate for Payer: Humana KY Medicaid |
$2,855.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,884.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,808.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,912.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,307.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,227.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,642.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.38
|
| Rate for Payer: PHCS Commercial |
$7,971.31
|
| Rate for Payer: United Healthcare All Payer |
$7,307.04
|
|
|
ANATOMICAL SHOLDR PEG GLND SM
|
Facility
|
IP
|
$8,303.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.03 |
| Max. Negotiated Rate |
$7,971.31 |
| Rate for Payer: Aetna Commercial |
$6,393.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,476.69
|
| Rate for Payer: Cash Price |
$4,151.73
|
| Rate for Payer: Cigna Commercial |
$6,891.86
|
| Rate for Payer: First Health Commercial |
$7,888.28
|
| Rate for Payer: Humana Commercial |
$7,057.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,808.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,307.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,227.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,642.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.38
|
| Rate for Payer: PHCS Commercial |
$7,971.31
|
| Rate for Payer: United Healthcare All Payer |
$7,307.04
|
|
|
ANATOMICAL SHOULDER BALL TAPER
|
Facility
|
OP
|
$7,387.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.19 |
| Max. Negotiated Rate |
$7,091.81 |
| Rate for Payer: Aetna Commercial |
$5,688.22
|
| Rate for Payer: Anthem Medicaid |
$2,540.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,762.09
|
| Rate for Payer: Cash Price |
$3,693.65
|
| Rate for Payer: Cigna Commercial |
$6,131.46
|
| Rate for Payer: First Health Commercial |
$7,017.94
|
| Rate for Payer: Humana Commercial |
$6,279.20
|
| Rate for Payer: Humana KY Medicaid |
$2,540.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,057.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,451.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,591.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,500.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,540.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,909.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,426.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,097.24
|
| Rate for Payer: PHCS Commercial |
$7,091.81
|
| Rate for Payer: United Healthcare All Payer |
$6,500.82
|
|
