|
3 D SIMULATION FIELD SETTING(T
|
Facility
|
IP
|
$6,258.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
333T0005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,877.40 |
| Max. Negotiated Rate |
$6,007.68 |
| Rate for Payer: Aetna Commercial |
$4,818.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,881.24
|
| Rate for Payer: Cash Price |
$3,129.00
|
| Rate for Payer: Cigna Commercial |
$5,194.14
|
| Rate for Payer: First Health Commercial |
$5,945.10
|
| Rate for Payer: Humana Commercial |
$5,319.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,131.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,618.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,877.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,507.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,693.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,006.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,444.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,318.02
|
| Rate for Payer: PHCS Commercial |
$6,007.68
|
| Rate for Payer: United Healthcare All Payer |
$5,507.04
|
|
|
40MM GLNOD W/46MM SURFC KEEL
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
40MM GLNOD W/46MM SURFC KEEL
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
42/24 TI GLENOSPHERE
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42/24 TI GLENOSPHERE
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +2.5 INF/24 TI GLENOSPHERE
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +2.5 INF/24 TI GLENOSPHERE
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +2.5 INF/28 TI GLENOSPHERE
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +2.5 INF/28 TI GLENOSPHERE
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42/28 TI GLENOSPHERE
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42/28 TI GLENOSPHERE
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +4 LAT/24 TI GLENOSPHERE
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +4 LAT/24 TI GLENOSPHERE
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +4 LAT/28 TI GLENOSPHERE
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
42 +4 LAT/28 TI GLENOSPHERE
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
46MM GLENOID W/40MM SURFCE PEG
|
Facility
|
IP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
46MM GLENOID W/40MM SURFCE PEG
|
Facility
|
OP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem Medicaid |
$3,195.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Humana KY Medicaid |
$3,195.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,259.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
46MM GLENOID W/52MM SURFCE PEG
|
Facility
|
IP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
46MM GLENOID W/52MM SURFCE PEG
|
Facility
|
OP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem Medicaid |
$3,195.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Humana KY Medicaid |
$3,195.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,259.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
46MM GLNOD 4/40MM SRFC KEEL
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
46MM GLNOD 4/40MM SRFC KEEL
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
46MM GLNOD W/52MM SUFC KEEL
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
46MM GLNOD W/52MM SUFC KEEL
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
4FR. PIGTAIL 65CM
|
Facility
|
OP
|
$488.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: Aetna Commercial |
$376.34
|
| Rate for Payer: Anthem Medicaid |
$168.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.23
|
| Rate for Payer: Cash Price |
$244.37
|
| Rate for Payer: Cigna Commercial |
$405.66
|
| Rate for Payer: First Health Commercial |
$464.31
|
| Rate for Payer: Humana Commercial |
$415.44
|
| Rate for Payer: Humana KY Medicaid |
$168.08
|
| Rate for Payer: Kentucky WC Medicaid |
$169.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.10
|
| Rate for Payer: Ohio Health Group HMO |
$366.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.24
|
| Rate for Payer: PHCS Commercial |
$469.20
|
| Rate for Payer: United Healthcare All Payer |
$430.10
|
|
|
4FR. PIGTAIL 65CM
|
Facility
|
IP
|
$488.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.62 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: Aetna Commercial |
$376.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.23
|
| Rate for Payer: Cash Price |
$244.37
|
| Rate for Payer: Cigna Commercial |
$405.66
|
| Rate for Payer: First Health Commercial |
$464.31
|
| Rate for Payer: Humana Commercial |
$415.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$430.10
|
| Rate for Payer: Ohio Health Group HMO |
$366.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.24
|
| Rate for Payer: PHCS Commercial |
$469.20
|
| Rate for Payer: United Healthcare All Payer |
$430.10
|
|
