|
ANATOMIC RAD HEAD STEM 8*2.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 8*4.0MM
|
Facility
|
IP
|
$8,971.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,691.42 |
| Max. Negotiated Rate |
$8,612.54 |
| Rate for Payer: Aetna Commercial |
$6,907.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,997.69
|
| Rate for Payer: Cash Price |
$4,485.70
|
| Rate for Payer: Cigna Commercial |
$7,446.26
|
| Rate for Payer: First Health Commercial |
$8,522.83
|
| Rate for Payer: Humana Commercial |
$7,625.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,356.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,620.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,894.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,728.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,177.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,805.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,190.27
|
| Rate for Payer: PHCS Commercial |
$8,612.54
|
| Rate for Payer: United Healthcare All Payer |
$7,894.83
|
|
|
ANATOMIC RAD HEAD STEM 8*4.0MM
|
Facility
|
OP
|
$8,971.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,691.42 |
| Max. Negotiated Rate |
$8,612.54 |
| Rate for Payer: Aetna Commercial |
$6,907.98
|
| Rate for Payer: Anthem Medicaid |
$3,085.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,997.69
|
| Rate for Payer: Cash Price |
$4,485.70
|
| Rate for Payer: Cigna Commercial |
$7,446.26
|
| Rate for Payer: First Health Commercial |
$8,522.83
|
| Rate for Payer: Humana Commercial |
$7,625.69
|
| Rate for Payer: Humana KY Medicaid |
$3,085.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,116.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,356.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,620.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,147.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,894.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,728.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,177.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,805.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,190.27
|
| Rate for Payer: PHCS Commercial |
$8,612.54
|
| Rate for Payer: United Healthcare All Payer |
$7,894.83
|
|
|
ANATOMIC RAD HEAD STEM 8*8.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 8*8.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 9*0.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 9*0.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 9*2.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 9*2.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 9*4.0MM
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
ANATOMIC RAD HEAD STEM 9*4.0MM
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
ANATOMIC RAD HEAD STEM 9*8.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HEAD STEM 9*8.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HED STEM 10*0.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HED STEM 10*0.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HED STEM 10*4.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HED STEM 10*4.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HED STEM 10*8.0MM
|
Facility
|
IP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANATOMIC RAD HED STEM 10*8.0MM
|
Facility
|
OP
|
$7,978.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,393.58 |
| Max. Negotiated Rate |
$7,659.46 |
| Rate for Payer: Aetna Commercial |
$6,143.52
|
| Rate for Payer: Anthem Medicaid |
$2,743.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.31
|
| Rate for Payer: Cash Price |
$3,989.30
|
| Rate for Payer: Cigna Commercial |
$6,622.24
|
| Rate for Payer: First Health Commercial |
$7,579.67
|
| Rate for Payer: Humana Commercial |
$6,781.81
|
| Rate for Payer: Humana KY Medicaid |
$2,743.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,798.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,983.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,382.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,941.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,505.23
|
| Rate for Payer: PHCS Commercial |
$7,659.46
|
| Rate for Payer: United Healthcare All Payer |
$7,021.17
|
|
|
ANAT SHOULDER REM HEAD 14*40
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 14*40
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 15*42
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 15*42
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 16*44
|
Facility
|
OP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem Medicaid |
$3,744.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Humana KY Medicaid |
$3,744.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
|
ANAT SHOULDER REM HEAD 16*44
|
Facility
|
IP
|
$10,887.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.31 |
| Max. Negotiated Rate |
$10,452.20 |
| Rate for Payer: Aetna Commercial |
$8,383.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,492.41
|
| Rate for Payer: Cash Price |
$5,443.85
|
| Rate for Payer: Cigna Commercial |
$9,036.80
|
| Rate for Payer: First Health Commercial |
$10,343.32
|
| Rate for Payer: Humana Commercial |
$9,254.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,035.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,581.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,710.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,472.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.52
|
| Rate for Payer: PHCS Commercial |
$10,452.20
|
| Rate for Payer: United Healthcare All Payer |
$9,581.18
|
|
