|
HEAD BIOLOX CER V40 32MM -4
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
HEAD BIOLOX CER V40 36MM +0
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +0
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +2.5
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +2.5
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM -2.5
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM -2.5
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +5
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +5
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM -5
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM -5
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +7.5
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX CER V40 36MM +7.5
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD BIOLOX UNIV TPR 28MM
|
Facility
|
IP
|
$9,676.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.96 |
| Max. Negotiated Rate |
$9,289.54 |
| Rate for Payer: Aetna Commercial |
$7,450.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,547.75
|
| Rate for Payer: Cash Price |
$4,838.30
|
| Rate for Payer: Cigna Commercial |
$8,031.58
|
| Rate for Payer: First Health Commercial |
$9,192.77
|
| Rate for Payer: Humana Commercial |
$8,225.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,934.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,515.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,257.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,935.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.75
|
| Rate for Payer: PHCS Commercial |
$9,289.54
|
| Rate for Payer: United Healthcare All Payer |
$8,515.41
|
|
|
HEAD BIOLOX UNIV TPR 28MM
|
Facility
|
OP
|
$9,676.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.96 |
| Max. Negotiated Rate |
$9,289.54 |
| Rate for Payer: Aetna Commercial |
$7,450.98
|
| Rate for Payer: Anthem Medicaid |
$3,327.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,547.75
|
| Rate for Payer: Cash Price |
$4,838.30
|
| Rate for Payer: Cigna Commercial |
$8,031.58
|
| Rate for Payer: First Health Commercial |
$9,192.77
|
| Rate for Payer: Humana Commercial |
$8,225.11
|
| Rate for Payer: Humana KY Medicaid |
$3,327.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,361.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,934.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,394.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,515.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,257.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,935.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.75
|
| Rate for Payer: PHCS Commercial |
$9,289.54
|
| Rate for Payer: United Healthcare All Payer |
$8,515.41
|
|
|
HEAD BIOLOX UNIV TPR 32MM
|
Facility
|
OP
|
$9,676.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.96 |
| Max. Negotiated Rate |
$9,289.54 |
| Rate for Payer: Aetna Commercial |
$7,450.98
|
| Rate for Payer: Anthem Medicaid |
$3,327.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,547.75
|
| Rate for Payer: Cash Price |
$4,838.30
|
| Rate for Payer: Cigna Commercial |
$8,031.58
|
| Rate for Payer: First Health Commercial |
$9,192.77
|
| Rate for Payer: Humana Commercial |
$8,225.11
|
| Rate for Payer: Humana KY Medicaid |
$3,327.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,361.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,934.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,394.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,515.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,257.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,935.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.75
|
| Rate for Payer: PHCS Commercial |
$9,289.54
|
| Rate for Payer: United Healthcare All Payer |
$8,515.41
|
|
|
HEAD BIOLOX UNIV TPR 32MM
|
Facility
|
IP
|
$9,676.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.96 |
| Max. Negotiated Rate |
$9,289.54 |
| Rate for Payer: Aetna Commercial |
$7,450.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,547.75
|
| Rate for Payer: Cash Price |
$4,838.30
|
| Rate for Payer: Cigna Commercial |
$8,031.58
|
| Rate for Payer: First Health Commercial |
$9,192.77
|
| Rate for Payer: Humana Commercial |
$8,225.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,934.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,515.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,257.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,935.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.75
|
| Rate for Payer: PHCS Commercial |
$9,289.54
|
| Rate for Payer: United Healthcare All Payer |
$8,515.41
|
|
|
HEAD BIOLOX UNIV TPR 36MM
|
Facility
|
OP
|
$10,883.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.82 |
| Max. Negotiated Rate |
$10,447.91 |
| Rate for Payer: Aetna Commercial |
$8,380.09
|
| Rate for Payer: Anthem Medicaid |
$3,742.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,488.93
|
| Rate for Payer: Cash Price |
$5,441.62
|
| Rate for Payer: Cigna Commercial |
$9,033.09
|
| Rate for Payer: First Health Commercial |
$10,339.08
|
| Rate for Payer: Humana Commercial |
$9,250.75
|
| Rate for Payer: Humana KY Medicaid |
$3,742.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,780.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,924.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,031.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,264.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,817.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,577.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,162.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,176.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,414.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,373.80
|
| Rate for Payer: PHCS Commercial |
$10,447.91
|
| Rate for Payer: United Healthcare All Payer |
$9,577.25
|
|
|
HEAD BIOLOX UNIV TPR 36MM
|
Facility
|
IP
|
$10,883.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.82 |
| Max. Negotiated Rate |
$10,447.91 |
| Rate for Payer: Aetna Commercial |
$8,380.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,488.93
|
| Rate for Payer: Cash Price |
$5,441.62
|
| Rate for Payer: Cigna Commercial |
$9,033.09
|
| Rate for Payer: First Health Commercial |
$10,339.08
|
| Rate for Payer: Humana Commercial |
$9,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,924.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,031.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,264.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,577.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,162.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,176.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,414.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,373.80
|
| Rate for Payer: PHCS Commercial |
$10,447.91
|
| Rate for Payer: United Healthcare All Payer |
$9,577.25
|
|
|
HEAD BIOLOX UNIV TPR 40MM
|
Facility
|
IP
|
$10,883.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.82 |
| Max. Negotiated Rate |
$10,447.91 |
| Rate for Payer: Aetna Commercial |
$8,380.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,488.93
|
| Rate for Payer: Cash Price |
$5,441.62
|
| Rate for Payer: Cigna Commercial |
$9,033.09
|
| Rate for Payer: First Health Commercial |
$10,339.08
|
| Rate for Payer: Humana Commercial |
$9,250.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,924.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,031.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,264.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,577.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,162.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,176.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,414.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,373.80
|
| Rate for Payer: PHCS Commercial |
$10,447.91
|
| Rate for Payer: United Healthcare All Payer |
$9,577.25
|
|
|
HEAD BIOLOX UNIV TPR 40MM
|
Facility
|
OP
|
$10,883.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.82 |
| Max. Negotiated Rate |
$10,447.91 |
| Rate for Payer: Aetna Commercial |
$8,380.09
|
| Rate for Payer: Anthem Medicaid |
$3,742.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,488.93
|
| Rate for Payer: Cash Price |
$5,441.62
|
| Rate for Payer: Cigna Commercial |
$9,033.09
|
| Rate for Payer: First Health Commercial |
$10,339.08
|
| Rate for Payer: Humana Commercial |
$9,250.75
|
| Rate for Payer: Humana KY Medicaid |
$3,742.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,780.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,924.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,031.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,264.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,817.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,577.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,162.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,176.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,414.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,373.80
|
| Rate for Payer: PHCS Commercial |
$10,447.91
|
| Rate for Payer: United Healthcare All Payer |
$9,577.25
|
|
|
HEAD BIOLOX UNIV TPR 44MM
|
Facility
|
OP
|
$10,088.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.48 |
| Max. Negotiated Rate |
$9,684.79 |
| Rate for Payer: Aetna Commercial |
$7,768.01
|
| Rate for Payer: Anthem Medicaid |
$3,469.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,868.89
|
| Rate for Payer: Cash Price |
$5,044.16
|
| Rate for Payer: Cigna Commercial |
$8,373.31
|
| Rate for Payer: First Health Commercial |
$9,583.90
|
| Rate for Payer: Humana Commercial |
$8,575.07
|
| Rate for Payer: Humana KY Medicaid |
$3,469.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,504.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,272.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,445.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,026.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,538.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,877.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,566.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,017.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,311.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,127.38
|
| Rate for Payer: PHCS Commercial |
$9,684.79
|
| Rate for Payer: United Healthcare All Payer |
$8,877.72
|
|
|
HEAD BIOLOX UNIV TPR 44MM
|
Facility
|
IP
|
$10,088.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.48 |
| Max. Negotiated Rate |
$9,684.79 |
| Rate for Payer: Aetna Commercial |
$7,768.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,868.89
|
| Rate for Payer: Cash Price |
$5,044.16
|
| Rate for Payer: Cigna Commercial |
$8,373.31
|
| Rate for Payer: First Health Commercial |
$9,583.90
|
| Rate for Payer: Humana Commercial |
$8,575.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,272.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,445.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,026.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,877.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,566.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,017.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,311.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,127.38
|
| Rate for Payer: PHCS Commercial |
$9,684.79
|
| Rate for Payer: United Healthcare All Payer |
$8,877.72
|
|
|
HEAD CEMNTD CUP PLACEMENT 36MM
|
Facility
|
OP
|
$2,107.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.98 |
| Max. Negotiated Rate |
$2,023.27 |
| Rate for Payer: Aetna Commercial |
$1,622.83
|
| Rate for Payer: Anthem Medicaid |
$724.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,643.90
|
| Rate for Payer: Cash Price |
$1,053.79
|
| Rate for Payer: Cigna Commercial |
$1,749.28
|
| Rate for Payer: First Health Commercial |
$2,002.19
|
| Rate for Payer: Humana Commercial |
$1,791.43
|
| Rate for Payer: Humana KY Medicaid |
$724.79
|
| Rate for Payer: Kentucky WC Medicaid |
$732.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,728.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,555.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,854.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,580.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.35
|
| Rate for Payer: PHCS Commercial |
$2,023.27
|
| Rate for Payer: United Healthcare All Payer |
$1,854.66
|
|
|
HEAD CEMNTD CUP PLACEMENT 36MM
|
Facility
|
IP
|
$2,107.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.98 |
| Max. Negotiated Rate |
$2,023.27 |
| Rate for Payer: Aetna Commercial |
$1,622.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,643.90
|
| Rate for Payer: Cash Price |
$1,053.79
|
| Rate for Payer: Cigna Commercial |
$1,749.28
|
| Rate for Payer: First Health Commercial |
$2,002.19
|
| Rate for Payer: Humana Commercial |
$1,791.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,728.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,555.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,854.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,580.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.35
|
| Rate for Payer: PHCS Commercial |
$2,023.27
|
| Rate for Payer: United Healthcare All Payer |
$1,854.66
|
|
