|
HEAD FEM BIOX DELTA ART 32MM +
|
Facility
|
IP
|
$11,147.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,344.26 |
| Max. Negotiated Rate |
$10,701.65 |
| Rate for Payer: Aetna Commercial |
$8,583.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,695.09
|
| Rate for Payer: Cash Price |
$5,573.77
|
| Rate for Payer: Cigna Commercial |
$9,252.47
|
| Rate for Payer: First Health Commercial |
$10,590.17
|
| Rate for Payer: Humana Commercial |
$9,475.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,140.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,226.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,344.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,360.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,918.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,698.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,691.81
|
| Rate for Payer: PHCS Commercial |
$10,701.65
|
| Rate for Payer: United Healthcare All Payer |
$9,809.84
|
|
|
HEAD FEM BIOX DELTA ART 32MM +
|
Facility
|
OP
|
$11,147.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,344.26 |
| Max. Negotiated Rate |
$10,701.65 |
| Rate for Payer: Aetna Commercial |
$8,583.61
|
| Rate for Payer: Anthem Medicaid |
$3,833.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,695.09
|
| Rate for Payer: Cash Price |
$5,573.77
|
| Rate for Payer: Cigna Commercial |
$9,252.47
|
| Rate for Payer: First Health Commercial |
$10,590.17
|
| Rate for Payer: Humana Commercial |
$9,475.42
|
| Rate for Payer: Humana KY Medicaid |
$3,833.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,872.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,140.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,226.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,344.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,910.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,360.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,918.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,698.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,691.81
|
| Rate for Payer: PHCS Commercial |
$10,701.65
|
| Rate for Payer: United Healthcare All Payer |
$9,809.84
|
|
|
HEAD FEM COCR 12/14 28MM +3.5
|
Facility
|
IP
|
$4,671.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.56 |
| Max. Negotiated Rate |
$4,485.00 |
| Rate for Payer: Aetna Commercial |
$3,597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.07
|
| Rate for Payer: Cash Price |
$2,335.94
|
| Rate for Payer: Cigna Commercial |
$3,877.66
|
| Rate for Payer: First Health Commercial |
$4,438.29
|
| Rate for Payer: Humana Commercial |
$3,971.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,830.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,447.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,111.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,503.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,064.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,223.60
|
| Rate for Payer: PHCS Commercial |
$4,485.00
|
| Rate for Payer: United Healthcare All Payer |
$4,111.25
|
|
|
HEAD FEM COCR 12/14 28MM +3.5
|
Facility
|
OP
|
$4,671.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.56 |
| Max. Negotiated Rate |
$4,485.00 |
| Rate for Payer: Aetna Commercial |
$3,597.35
|
| Rate for Payer: Anthem Medicaid |
$1,606.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,644.07
|
| Rate for Payer: Cash Price |
$2,335.94
|
| Rate for Payer: Cigna Commercial |
$3,877.66
|
| Rate for Payer: First Health Commercial |
$4,438.29
|
| Rate for Payer: Humana Commercial |
$3,971.10
|
| Rate for Payer: Humana KY Medicaid |
$1,606.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,830.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,447.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,401.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,638.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,111.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,503.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,737.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,064.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,223.60
|
| Rate for Payer: PHCS Commercial |
$4,485.00
|
| Rate for Payer: United Healthcare All Payer |
$4,111.25
|
|
|
HEAD FEMORAL V40 22MM
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD FEMORAL V40 22MM
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD FRACTURE MOD CATHCART 47M
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HEAD FRACTURE MOD CATHCART 47M
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HEAD FRACTURE MOD CATHCART 53M
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HEAD FRACTURE MOD CATHCART 53M
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HEAD FRACTURE MOD CATHCART 54M
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HEAD FRACTURE MOD CATHCART 54M
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HEAD HIP MOLD 48MM
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 48MM
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 52MM
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 52MM
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 56MM
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 56MM
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 60MM
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 60MM
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 64MM
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HIP MOLD 64MM
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
HEAD HUMERAL 42MM*17MM
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
HEAD HUMERAL 42MM*17MM
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
HEAD HUMERAL 44MM*17MM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
