|
GLENOID 58/55 HEAD ART 19*20MM
|
Facility
|
IP
|
$8,738.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.01 |
| Max. Negotiated Rate |
$8,389.01 |
| Rate for Payer: Aetna Commercial |
$6,728.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.07
|
| Rate for Payer: Cash Price |
$4,369.27
|
| Rate for Payer: Cigna Commercial |
$7,253.00
|
| Rate for Payer: First Health Commercial |
$8,301.62
|
| Rate for Payer: Humana Commercial |
$7,427.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,165.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,689.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,553.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,708.95
|
| Rate for Payer: PHCS Commercial |
$8,389.01
|
| Rate for Payer: United Healthcare All Payer |
$7,689.92
|
|
|
GLENOID 58/55 HEAD ART 20*25M
|
Facility
|
OP
|
$8,738.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.01 |
| Max. Negotiated Rate |
$8,389.01 |
| Rate for Payer: Aetna Commercial |
$6,728.68
|
| Rate for Payer: Anthem Medicaid |
$3,005.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.07
|
| Rate for Payer: Cash Price |
$4,369.27
|
| Rate for Payer: Cigna Commercial |
$7,253.00
|
| Rate for Payer: First Health Commercial |
$8,301.62
|
| Rate for Payer: Humana Commercial |
$7,427.77
|
| Rate for Payer: Humana KY Medicaid |
$3,005.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,035.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,165.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,065.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,689.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,553.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,708.95
|
| Rate for Payer: PHCS Commercial |
$8,389.01
|
| Rate for Payer: United Healthcare All Payer |
$7,689.92
|
|
|
GLENOID 58/55 HEAD ART 20*25M
|
Facility
|
IP
|
$8,738.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.01 |
| Max. Negotiated Rate |
$8,389.01 |
| Rate for Payer: Aetna Commercial |
$6,728.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.07
|
| Rate for Payer: Cash Price |
$4,369.27
|
| Rate for Payer: Cigna Commercial |
$7,253.00
|
| Rate for Payer: First Health Commercial |
$8,301.62
|
| Rate for Payer: Humana Commercial |
$7,427.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,165.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,689.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,553.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,708.95
|
| Rate for Payer: PHCS Commercial |
$8,389.01
|
| Rate for Payer: United Healthcare All Payer |
$7,689.92
|
|
|
GLENOID BEARING INSERT STD
|
Facility
|
IP
|
$4,496.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.48 |
| Max. Negotiated Rate |
$4,316.16 |
| Rate for Payer: Aetna Commercial |
$3,461.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.88
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cigna Commercial |
$3,731.68
|
| Rate for Payer: First Health Commercial |
$4,271.20
|
| Rate for Payer: Humana Commercial |
$3,821.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,686.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,956.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,393.76
|
| Rate for Payer: PHCS Commercial |
$4,316.16
|
| Rate for Payer: United Healthcare All Payer |
$3,956.48
|
|
|
GLENOID BEARING INSERT STD
|
Facility
|
OP
|
$4,496.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.48 |
| Max. Negotiated Rate |
$4,316.16 |
| Rate for Payer: Aetna Commercial |
$3,461.92
|
| Rate for Payer: Anthem Medicaid |
$1,546.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.88
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cigna Commercial |
$3,731.68
|
| Rate for Payer: First Health Commercial |
$4,271.20
|
| Rate for Payer: Humana Commercial |
$3,821.60
|
| Rate for Payer: Humana KY Medicaid |
$1,546.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,561.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,686.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,956.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,393.76
|
| Rate for Payer: PHCS Commercial |
$4,316.16
|
| Rate for Payer: United Healthcare All Payer |
$3,956.48
|
|
|
GLENOID DIA 36
|
Facility
|
OP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem Medicaid |
$2,702.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Humana KY Medicaid |
$2,702.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
GLENOID DIA 36
|
Facility
|
IP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
GLENOID DIA 42
|
Facility
|
IP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
GLENOID DIA 42
|
Facility
|
OP
|
$7,858.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.66 |
| Max. Negotiated Rate |
$7,544.54 |
| Rate for Payer: Aetna Commercial |
$6,051.35
|
| Rate for Payer: Anthem Medicaid |
$2,702.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.94
|
| Rate for Payer: Cash Price |
$3,929.45
|
| Rate for Payer: Cigna Commercial |
$6,522.89
|
| Rate for Payer: First Health Commercial |
$7,465.96
|
| Rate for Payer: Humana Commercial |
$6,680.06
|
| Rate for Payer: Humana KY Medicaid |
$2,702.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,730.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,444.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,894.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,436.26
|
| Rate for Payer: PHCS Commercial |
$7,544.54
|
| Rate for Payer: United Healthcare All Payer |
$6,915.83
|
|
|
GLENOID PEGGED POLY W/PEG LG
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG LG
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG MED
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG MED
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG SM
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG SM
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG X LG
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID PEGGED POLY W/PEG X LG
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
GLENOID W/KEEL LARGE
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL LARGE
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL MED
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL MED
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL SMALL
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL SMALL
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL X LARGE
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
GLENOID W/KEEL X LARGE
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
