|
HEAD FRACTURE MOD CATHCART 47M
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HEAD FRACTURE MOD CATHCART 47M
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HEAD FRACTURE MOD CATHCART 53M
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HEAD FRACTURE MOD CATHCART 53M
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HEAD FRACTURE MOD CATHCART 54M
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HEAD FRACTURE MOD CATHCART 54M
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HEAD HIP MOLD 48MM
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 48MM
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 52MM
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 52MM
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 56MM
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 56MM
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 60MM
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 60MM
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 64MM
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HIP MOLD 64MM
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
HEAD HUMERAL 42MM*17MM
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
HEAD HUMERAL 42MM*17MM
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
HEAD HUMERAL 44MM*17MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 44MM*17MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 44MM*19MM
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
HEAD HUMERAL 44MM*19MM
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
HEAD HUMERAL 46MM*18MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 46MM*18MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 46MM*20MM
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
