|
ANATOMICAL SHLDR PEG GLND MED.
|
Facility
|
IP
|
$8,103.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.45 |
| Max. Negotiated Rate |
$7,779.31 |
| Rate for Payer: Aetna Commercial |
$6,239.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.69
|
| Rate for Payer: Cash Price |
$4,051.72
|
| Rate for Payer: Cigna Commercial |
$6,725.86
|
| Rate for Payer: First Health Commercial |
$7,698.28
|
| Rate for Payer: Humana Commercial |
$6,887.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,980.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,431.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,131.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,512.07
|
| Rate for Payer: PHCS Commercial |
$7,779.31
|
| Rate for Payer: United Healthcare All Payer |
$7,131.04
|
|
|
ANATOMICAL SHLDR PEG GLND MED.
|
Facility
|
OP
|
$8,103.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.45 |
| Max. Negotiated Rate |
$7,779.31 |
| Rate for Payer: Aetna Commercial |
$6,239.66
|
| Rate for Payer: Anthem Medicaid |
$2,786.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.69
|
| Rate for Payer: Cash Price |
$4,051.72
|
| Rate for Payer: Cigna Commercial |
$6,725.86
|
| Rate for Payer: First Health Commercial |
$7,698.28
|
| Rate for Payer: Humana Commercial |
$6,887.93
|
| Rate for Payer: Humana KY Medicaid |
$2,786.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,815.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,980.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,431.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,842.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,131.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,512.07
|
| Rate for Payer: PHCS Commercial |
$7,779.31
|
| Rate for Payer: United Healthcare All Payer |
$7,131.04
|
|
|
ANATOMICAL SHLDR RMV HD 14*40
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 14*40
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 15*42
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 15*42
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 16*44
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 16*44
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 16*46
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 16*46
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 17*48
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 17*48
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 18*50
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 18*50
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 19*52
|
Facility
|
OP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem Medicaid |
$3,730.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Humana KY Medicaid |
$3,730.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,768.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,805.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHLDR RMV HD 19*52
|
Facility
|
IP
|
$10,848.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.27 |
| Max. Negotiated Rate |
$10,414.27 |
| Rate for Payer: Aetna Commercial |
$8,353.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,461.60
|
| Rate for Payer: Cash Price |
$5,424.10
|
| Rate for Payer: Cigna Commercial |
$9,004.01
|
| Rate for Payer: First Health Commercial |
$10,305.79
|
| Rate for Payer: Humana Commercial |
$9,220.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,895.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,005.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,254.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,546.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,136.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,169.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,410.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,362.94
|
| Rate for Payer: PHCS Commercial |
$10,414.27
|
| Rate for Payer: United Healthcare All Payer |
$9,546.42
|
|
|
ANATOMICAL SHOLDR PEG GLND SM
|
Facility
|
OP
|
$8,103.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.45 |
| Max. Negotiated Rate |
$7,779.31 |
| Rate for Payer: Aetna Commercial |
$6,239.66
|
| Rate for Payer: Anthem Medicaid |
$2,786.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.69
|
| Rate for Payer: Cash Price |
$4,051.72
|
| Rate for Payer: Cigna Commercial |
$6,725.86
|
| Rate for Payer: First Health Commercial |
$7,698.28
|
| Rate for Payer: Humana Commercial |
$6,887.93
|
| Rate for Payer: Humana KY Medicaid |
$2,786.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,815.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,980.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,431.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,842.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,131.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,512.07
|
| Rate for Payer: PHCS Commercial |
$7,779.31
|
| Rate for Payer: United Healthcare All Payer |
$7,131.04
|
|
|
ANATOMICAL SHOLDR PEG GLND SM
|
Facility
|
IP
|
$8,103.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.45 |
| Max. Negotiated Rate |
$7,779.31 |
| Rate for Payer: Aetna Commercial |
$6,239.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.69
|
| Rate for Payer: Cash Price |
$4,051.72
|
| Rate for Payer: Cigna Commercial |
$6,725.86
|
| Rate for Payer: First Health Commercial |
$7,698.28
|
| Rate for Payer: Humana Commercial |
$6,887.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,980.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,431.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,131.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,512.07
|
| Rate for Payer: PHCS Commercial |
$7,779.31
|
| Rate for Payer: United Healthcare All Payer |
$7,131.04
|
|
|
ANATOMICAL SHOULDER BALL TAPER
|
Facility
|
OP
|
$7,187.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.35 |
| Max. Negotiated Rate |
$6,899.81 |
| Rate for Payer: Aetna Commercial |
$5,534.22
|
| Rate for Payer: Anthem Medicaid |
$2,471.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.09
|
| Rate for Payer: Cash Price |
$3,593.65
|
| Rate for Payer: Cigna Commercial |
$5,965.46
|
| Rate for Payer: First Health Commercial |
$6,827.94
|
| Rate for Payer: Humana Commercial |
$6,109.20
|
| Rate for Payer: Humana KY Medicaid |
$2,471.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,496.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,893.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,304.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,324.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,390.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.06
|
| Rate for Payer: PHCS Commercial |
$6,899.81
|
| Rate for Payer: United Healthcare All Payer |
$6,324.82
|
|
|
ANATOMICAL SHOULDER BALL TAPER
|
Facility
|
IP
|
$7,187.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.35 |
| Max. Negotiated Rate |
$6,899.81 |
| Rate for Payer: Aetna Commercial |
$5,534.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,606.09
|
| Rate for Payer: Cash Price |
$3,593.65
|
| Rate for Payer: Cigna Commercial |
$5,965.46
|
| Rate for Payer: First Health Commercial |
$6,827.94
|
| Rate for Payer: Humana Commercial |
$6,109.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,893.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,304.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,324.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,390.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.06
|
| Rate for Payer: PHCS Commercial |
$6,899.81
|
| Rate for Payer: United Healthcare All Payer |
$6,324.82
|
|
|
ANATOMICAL SHOULDER BALL TPR
|
Facility
|
IP
|
$7,553.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.99 |
| Max. Negotiated Rate |
$7,251.61 |
| Rate for Payer: Aetna Commercial |
$5,816.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,891.93
|
| Rate for Payer: Cash Price |
$3,776.88
|
| Rate for Payer: Cigna Commercial |
$6,269.62
|
| Rate for Payer: First Health Commercial |
$7,176.07
|
| Rate for Payer: Humana Commercial |
$6,420.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,194.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,574.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,647.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,665.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,341.67
|
| Rate for Payer: PHCS Commercial |
$7,251.61
|
| Rate for Payer: United Healthcare All Payer |
$6,647.31
|
|
|
ANATOMICAL SHOULDER BALL TPR
|
Facility
|
OP
|
$7,553.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.99 |
| Max. Negotiated Rate |
$7,251.61 |
| Rate for Payer: Aetna Commercial |
$5,816.40
|
| Rate for Payer: Anthem Medicaid |
$2,597.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,891.93
|
| Rate for Payer: Cash Price |
$3,776.88
|
| Rate for Payer: Cigna Commercial |
$6,269.62
|
| Rate for Payer: First Health Commercial |
$7,176.07
|
| Rate for Payer: Humana Commercial |
$6,420.70
|
| Rate for Payer: Humana KY Medicaid |
$2,597.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,624.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,194.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,574.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,649.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,647.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,665.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,341.67
|
| Rate for Payer: PHCS Commercial |
$7,251.61
|
| Rate for Payer: United Healthcare All Payer |
$6,647.31
|
|
|
ANATOMICL SHLDR KEEL GLENOID L
|
Facility
|
IP
|
$6,718.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.42 |
| Max. Negotiated Rate |
$6,449.89 |
| Rate for Payer: Aetna Commercial |
$5,173.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,240.54
|
| Rate for Payer: Cash Price |
$3,359.32
|
| Rate for Payer: Cigna Commercial |
$5,576.47
|
| Rate for Payer: First Health Commercial |
$6,382.71
|
| Rate for Payer: Humana Commercial |
$5,710.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,509.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,958.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,015.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,912.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,038.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,343.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$873.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,082.78
|
| Rate for Payer: PHCS Commercial |
$6,449.89
|
| Rate for Payer: United Healthcare All Payer |
$5,912.40
|
|
|
ANATOMICL SHLDR KEEL GLENOID L
|
Facility
|
OP
|
$6,718.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.42 |
| Max. Negotiated Rate |
$6,449.89 |
| Rate for Payer: Aetna Commercial |
$5,173.35
|
| Rate for Payer: Anthem Medicaid |
$2,310.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,240.54
|
| Rate for Payer: Cash Price |
$3,359.32
|
| Rate for Payer: Cigna Commercial |
$5,576.47
|
| Rate for Payer: First Health Commercial |
$6,382.71
|
| Rate for Payer: Humana Commercial |
$5,710.84
|
| Rate for Payer: Humana KY Medicaid |
$2,310.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,334.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,509.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,958.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,015.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,356.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,912.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,038.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,343.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$873.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,082.78
|
| Rate for Payer: PHCS Commercial |
$6,449.89
|
| Rate for Payer: United Healthcare All Payer |
$5,912.40
|
|
|
ANATOMICL SHLDR KEEL GLENOID M
|
Facility
|
IP
|
$6,716.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.14 |
| Max. Negotiated Rate |
$6,447.79 |
| Rate for Payer: Aetna Commercial |
$5,171.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,238.83
|
| Rate for Payer: Cash Price |
$3,358.22
|
| Rate for Payer: Cigna Commercial |
$5,574.65
|
| Rate for Payer: First Health Commercial |
$6,380.63
|
| Rate for Payer: Humana Commercial |
$5,708.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,507.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,956.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,014.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,910.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,343.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$873.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,082.10
|
| Rate for Payer: PHCS Commercial |
$6,447.79
|
| Rate for Payer: United Healthcare All Payer |
$5,910.48
|
|
