|
IMPLANT OS RS RESURF FMRL 3 L
|
Facility
|
OP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem Medicaid |
$24,588.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Humana KY Medicaid |
$24,588.02
|
| Rate for Payer: Kentucky WC Medicaid |
$24,838.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,081.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OS RS RESURF FMRL 3 R
|
Facility
|
OP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem Medicaid |
$24,588.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Humana KY Medicaid |
$24,588.02
|
| Rate for Payer: Kentucky WC Medicaid |
$24,838.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,081.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OS RS RESURF FMRL 3 R
|
Facility
|
IP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OS RS RESURF FMRL 5 L
|
Facility
|
IP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OS RS RESURF FMRL 5 L
|
Facility
|
OP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem Medicaid |
$24,588.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Humana KY Medicaid |
$24,588.02
|
| Rate for Payer: Kentucky WC Medicaid |
$24,838.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,081.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OS RS RESURF FMRL 5 R
|
Facility
|
IP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OS RS RESURF FMRL 5 R
|
Facility
|
OP
|
$71,497.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,449.28 |
| Max. Negotiated Rate |
$68,637.70 |
| Rate for Payer: Aetna Commercial |
$55,053.15
|
| Rate for Payer: Anthem Medicaid |
$24,588.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,768.13
|
| Rate for Payer: Cash Price |
$35,748.80
|
| Rate for Payer: Cigna Commercial |
$59,343.01
|
| Rate for Payer: First Health Commercial |
$67,922.72
|
| Rate for Payer: Humana Commercial |
$60,772.96
|
| Rate for Payer: Humana KY Medicaid |
$24,588.02
|
| Rate for Payer: Kentucky WC Medicaid |
$24,838.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,628.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,765.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,449.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,081.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,917.89
|
| Rate for Payer: Ohio Health Group HMO |
$53,623.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,198.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,202.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,333.34
|
| Rate for Payer: PHCS Commercial |
$68,637.70
|
| Rate for Payer: United Healthcare All Payer |
$62,917.89
|
|
|
IMPLANT OSS RESRFCE FEM L 3CM
|
Facility
|
OP
|
$72,592.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,777.60 |
| Max. Negotiated Rate |
$69,688.32 |
| Rate for Payer: Aetna Commercial |
$55,895.84
|
| Rate for Payer: Anthem Medicaid |
$24,964.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,621.76
|
| Rate for Payer: Cash Price |
$36,296.00
|
| Rate for Payer: Cigna Commercial |
$60,251.36
|
| Rate for Payer: First Health Commercial |
$68,962.40
|
| Rate for Payer: Humana Commercial |
$61,703.20
|
| Rate for Payer: Humana KY Medicaid |
$24,964.39
|
| Rate for Payer: Kentucky WC Medicaid |
$25,218.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,525.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,777.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,465.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,880.96
|
| Rate for Payer: Ohio Health Group HMO |
$54,444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,073.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,155.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,088.48
|
| Rate for Payer: PHCS Commercial |
$69,688.32
|
| Rate for Payer: United Healthcare All Payer |
$63,880.96
|
|
|
IMPLANT OSS RESRFCE FEM L 3CM
|
Facility
|
IP
|
$72,592.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,777.60 |
| Max. Negotiated Rate |
$69,688.32 |
| Rate for Payer: Aetna Commercial |
$55,895.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,621.76
|
| Rate for Payer: Cash Price |
$36,296.00
|
| Rate for Payer: Cigna Commercial |
$60,251.36
|
| Rate for Payer: First Health Commercial |
$68,962.40
|
| Rate for Payer: Humana Commercial |
$61,703.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,525.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,777.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,880.96
|
| Rate for Payer: Ohio Health Group HMO |
$54,444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,073.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,155.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,088.48
|
| Rate for Payer: PHCS Commercial |
$69,688.32
|
| Rate for Payer: United Healthcare All Payer |
$63,880.96
|
|
|
IMPLANT OSS RESRFCE FEM R 3CM
|
Facility
|
IP
|
$72,592.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,777.60 |
| Max. Negotiated Rate |
$69,688.32 |
| Rate for Payer: Aetna Commercial |
$55,895.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,621.76
|
| Rate for Payer: Cash Price |
$36,296.00
|
| Rate for Payer: Cigna Commercial |
$60,251.36
|
| Rate for Payer: First Health Commercial |
$68,962.40
|
| Rate for Payer: Humana Commercial |
$61,703.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,525.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,777.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,880.96
|
| Rate for Payer: Ohio Health Group HMO |
$54,444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,073.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,155.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,088.48
|
| Rate for Payer: PHCS Commercial |
$69,688.32
|
| Rate for Payer: United Healthcare All Payer |
$63,880.96
|
|
|
IMPLANT OSS RESRFCE FEM R 3CM
|
Facility
|
OP
|
$72,592.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,777.60 |
| Max. Negotiated Rate |
$69,688.32 |
| Rate for Payer: Aetna Commercial |
$55,895.84
|
| Rate for Payer: Anthem Medicaid |
$24,964.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,621.76
|
| Rate for Payer: Cash Price |
$36,296.00
|
| Rate for Payer: Cigna Commercial |
$60,251.36
|
| Rate for Payer: First Health Commercial |
$68,962.40
|
| Rate for Payer: Humana Commercial |
$61,703.20
|
| Rate for Payer: Humana KY Medicaid |
$24,964.39
|
| Rate for Payer: Kentucky WC Medicaid |
$25,218.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,525.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,572.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,777.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,465.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,880.96
|
| Rate for Payer: Ohio Health Group HMO |
$54,444.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,073.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,155.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,088.48
|
| Rate for Payer: PHCS Commercial |
$69,688.32
|
| Rate for Payer: United Healthcare All Payer |
$63,880.96
|
|
|
IMPLANT OSS RESURFACING 3CM L
|
Facility
|
OP
|
$70,709.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,212.72 |
| Max. Negotiated Rate |
$67,880.70 |
| Rate for Payer: Aetna Commercial |
$54,445.98
|
| Rate for Payer: Anthem Medicaid |
$24,316.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,153.07
|
| Rate for Payer: Cash Price |
$35,354.53
|
| Rate for Payer: Cigna Commercial |
$58,688.52
|
| Rate for Payer: First Health Commercial |
$67,173.61
|
| Rate for Payer: Humana Commercial |
$60,102.70
|
| Rate for Payer: Humana KY Medicaid |
$24,316.85
|
| Rate for Payer: Kentucky WC Medicaid |
$24,564.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,981.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,212.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,804.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,223.97
|
| Rate for Payer: Ohio Health Group HMO |
$53,031.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,567.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,516.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,789.25
|
| Rate for Payer: PHCS Commercial |
$67,880.70
|
| Rate for Payer: United Healthcare All Payer |
$62,223.97
|
|
|
IMPLANT OSS RESURFACING 3CM L
|
Facility
|
IP
|
$70,709.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,212.72 |
| Max. Negotiated Rate |
$67,880.70 |
| Rate for Payer: Aetna Commercial |
$54,445.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,153.07
|
| Rate for Payer: Cash Price |
$35,354.53
|
| Rate for Payer: Cigna Commercial |
$58,688.52
|
| Rate for Payer: First Health Commercial |
$67,173.61
|
| Rate for Payer: Humana Commercial |
$60,102.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,981.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,212.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,223.97
|
| Rate for Payer: Ohio Health Group HMO |
$53,031.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,567.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,516.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,789.25
|
| Rate for Payer: PHCS Commercial |
$67,880.70
|
| Rate for Payer: United Healthcare All Payer |
$62,223.97
|
|
|
IMPLANT OSS RESURFACING 3CM R
|
Facility
|
OP
|
$70,709.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,212.72 |
| Max. Negotiated Rate |
$67,880.70 |
| Rate for Payer: Aetna Commercial |
$54,445.98
|
| Rate for Payer: Anthem Medicaid |
$24,316.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,153.07
|
| Rate for Payer: Cash Price |
$35,354.53
|
| Rate for Payer: Cigna Commercial |
$58,688.52
|
| Rate for Payer: First Health Commercial |
$67,173.61
|
| Rate for Payer: Humana Commercial |
$60,102.70
|
| Rate for Payer: Humana KY Medicaid |
$24,316.85
|
| Rate for Payer: Kentucky WC Medicaid |
$24,564.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,981.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,212.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,804.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,223.97
|
| Rate for Payer: Ohio Health Group HMO |
$53,031.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,567.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,516.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,789.25
|
| Rate for Payer: PHCS Commercial |
$67,880.70
|
| Rate for Payer: United Healthcare All Payer |
$62,223.97
|
|
|
IMPLANT OSS RESURFACING 3CM R
|
Facility
|
IP
|
$70,709.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,212.72 |
| Max. Negotiated Rate |
$67,880.70 |
| Rate for Payer: Aetna Commercial |
$54,445.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,153.07
|
| Rate for Payer: Cash Price |
$35,354.53
|
| Rate for Payer: Cigna Commercial |
$58,688.52
|
| Rate for Payer: First Health Commercial |
$67,173.61
|
| Rate for Payer: Humana Commercial |
$60,102.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,981.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,212.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,223.97
|
| Rate for Payer: Ohio Health Group HMO |
$53,031.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,567.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,516.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,789.25
|
| Rate for Payer: PHCS Commercial |
$67,880.70
|
| Rate for Payer: United Healthcare All Payer |
$62,223.97
|
|
|
IMPLANT OSS RESURFACING 5CM L
|
Facility
|
IP
|
$71,606.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,482.09 |
| Max. Negotiated Rate |
$68,742.68 |
| Rate for Payer: Aetna Commercial |
$55,137.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,853.43
|
| Rate for Payer: Cash Price |
$35,803.48
|
| Rate for Payer: Cigna Commercial |
$59,433.78
|
| Rate for Payer: First Health Commercial |
$68,026.61
|
| Rate for Payer: Humana Commercial |
$60,865.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,717.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,845.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,482.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,014.12
|
| Rate for Payer: Ohio Health Group HMO |
$53,705.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,285.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,298.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,408.80
|
| Rate for Payer: PHCS Commercial |
$68,742.68
|
| Rate for Payer: United Healthcare All Payer |
$63,014.12
|
|
|
IMPLANT OSS RESURFACING 5CM L
|
Facility
|
OP
|
$71,606.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,482.09 |
| Max. Negotiated Rate |
$68,742.68 |
| Rate for Payer: Aetna Commercial |
$55,137.36
|
| Rate for Payer: Anthem Medicaid |
$24,625.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,853.43
|
| Rate for Payer: Cash Price |
$35,803.48
|
| Rate for Payer: Cigna Commercial |
$59,433.78
|
| Rate for Payer: First Health Commercial |
$68,026.61
|
| Rate for Payer: Humana Commercial |
$60,865.92
|
| Rate for Payer: Humana KY Medicaid |
$24,625.63
|
| Rate for Payer: Kentucky WC Medicaid |
$24,876.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,717.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,845.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,482.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,119.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,014.12
|
| Rate for Payer: Ohio Health Group HMO |
$53,705.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,285.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,298.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,408.80
|
| Rate for Payer: PHCS Commercial |
$68,742.68
|
| Rate for Payer: United Healthcare All Payer |
$63,014.12
|
|
|
IMPLANT OSS RESURFACING 5CM R
|
Facility
|
IP
|
$71,606.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,482.09 |
| Max. Negotiated Rate |
$68,742.68 |
| Rate for Payer: Aetna Commercial |
$55,137.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,853.43
|
| Rate for Payer: Cash Price |
$35,803.48
|
| Rate for Payer: Cigna Commercial |
$59,433.78
|
| Rate for Payer: First Health Commercial |
$68,026.61
|
| Rate for Payer: Humana Commercial |
$60,865.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,717.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,845.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,482.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,014.12
|
| Rate for Payer: Ohio Health Group HMO |
$53,705.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,285.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,298.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,408.80
|
| Rate for Payer: PHCS Commercial |
$68,742.68
|
| Rate for Payer: United Healthcare All Payer |
$63,014.12
|
|
|
IMPLANT OSS RESURFACING 5CM R
|
Facility
|
OP
|
$71,606.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,482.09 |
| Max. Negotiated Rate |
$68,742.68 |
| Rate for Payer: Aetna Commercial |
$55,137.36
|
| Rate for Payer: Anthem Medicaid |
$24,625.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,853.43
|
| Rate for Payer: Cash Price |
$35,803.48
|
| Rate for Payer: Cigna Commercial |
$59,433.78
|
| Rate for Payer: First Health Commercial |
$68,026.61
|
| Rate for Payer: Humana Commercial |
$60,865.92
|
| Rate for Payer: Humana KY Medicaid |
$24,625.63
|
| Rate for Payer: Kentucky WC Medicaid |
$24,876.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,717.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,845.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,482.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,119.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,014.12
|
| Rate for Payer: Ohio Health Group HMO |
$53,705.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,285.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,298.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,408.80
|
| Rate for Payer: PHCS Commercial |
$68,742.68
|
| Rate for Payer: United Healthcare All Payer |
$63,014.12
|
|
|
IMPLANT OSS RESURF FEM 5CM L
|
Facility
|
IP
|
$73,991.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,197.58 |
| Max. Negotiated Rate |
$71,032.24 |
| Rate for Payer: Aetna Commercial |
$56,973.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,713.70
|
| Rate for Payer: Cash Price |
$36,995.96
|
| Rate for Payer: Cigna Commercial |
$61,413.29
|
| Rate for Payer: First Health Commercial |
$70,292.32
|
| Rate for Payer: Humana Commercial |
$62,893.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,673.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,606.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,197.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,112.89
|
| Rate for Payer: Ohio Health Group HMO |
$55,493.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,193.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,372.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,054.42
|
| Rate for Payer: PHCS Commercial |
$71,032.24
|
| Rate for Payer: United Healthcare All Payer |
$65,112.89
|
|
|
IMPLANT OSS RESURF FEM 5CM L
|
Facility
|
OP
|
$73,991.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,197.58 |
| Max. Negotiated Rate |
$71,032.24 |
| Rate for Payer: Aetna Commercial |
$56,973.78
|
| Rate for Payer: Anthem Medicaid |
$25,445.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,713.70
|
| Rate for Payer: Cash Price |
$36,995.96
|
| Rate for Payer: Cigna Commercial |
$61,413.29
|
| Rate for Payer: First Health Commercial |
$70,292.32
|
| Rate for Payer: Humana Commercial |
$62,893.13
|
| Rate for Payer: Humana KY Medicaid |
$25,445.82
|
| Rate for Payer: Kentucky WC Medicaid |
$25,704.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,673.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,606.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,197.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,956.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,112.89
|
| Rate for Payer: Ohio Health Group HMO |
$55,493.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,193.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,372.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,054.42
|
| Rate for Payer: PHCS Commercial |
$71,032.24
|
| Rate for Payer: United Healthcare All Payer |
$65,112.89
|
|
|
IMPLANT OSS RESURF FEM 5CM R
|
Facility
|
OP
|
$73,990.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,197.12 |
| Max. Negotiated Rate |
$71,030.78 |
| Rate for Payer: Aetna Commercial |
$56,972.61
|
| Rate for Payer: Anthem Medicaid |
$25,445.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,712.51
|
| Rate for Payer: Cash Price |
$36,995.20
|
| Rate for Payer: Cigna Commercial |
$61,412.03
|
| Rate for Payer: First Health Commercial |
$70,290.88
|
| Rate for Payer: Humana Commercial |
$62,891.84
|
| Rate for Payer: Humana KY Medicaid |
$25,445.30
|
| Rate for Payer: Kentucky WC Medicaid |
$25,704.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,672.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,604.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,197.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,955.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,111.55
|
| Rate for Payer: Ohio Health Group HMO |
$55,492.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,192.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,371.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,053.38
|
| Rate for Payer: PHCS Commercial |
$71,030.78
|
| Rate for Payer: United Healthcare All Payer |
$65,111.55
|
|
|
IMPLANT OSS RESURF FEM 5CM R
|
Facility
|
IP
|
$73,990.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,197.12 |
| Max. Negotiated Rate |
$71,030.78 |
| Rate for Payer: Aetna Commercial |
$56,972.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,712.51
|
| Rate for Payer: Cash Price |
$36,995.20
|
| Rate for Payer: Cigna Commercial |
$61,412.03
|
| Rate for Payer: First Health Commercial |
$70,290.88
|
| Rate for Payer: Humana Commercial |
$62,891.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,672.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,604.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,197.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,111.55
|
| Rate for Payer: Ohio Health Group HMO |
$55,492.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,192.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,371.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,053.38
|
| Rate for Payer: PHCS Commercial |
$71,030.78
|
| Rate for Payer: United Healthcare All Payer |
$65,111.55
|
|
|
IMPLANT OSS RESURF FEM SLEVE L
|
Facility
|
IP
|
$8,483.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.13 |
| Max. Negotiated Rate |
$8,144.41 |
| Rate for Payer: Aetna Commercial |
$6,532.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,617.33
|
| Rate for Payer: Cash Price |
$4,241.88
|
| Rate for Payer: Cigna Commercial |
$7,041.52
|
| Rate for Payer: First Health Commercial |
$8,059.57
|
| Rate for Payer: Humana Commercial |
$7,211.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,956.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,261.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,465.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,362.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,787.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,380.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.79
|
| Rate for Payer: PHCS Commercial |
$8,144.41
|
| Rate for Payer: United Healthcare All Payer |
$7,465.71
|
|
|
IMPLANT OSS RESURF FEM SLEVE L
|
Facility
|
OP
|
$8,483.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.13 |
| Max. Negotiated Rate |
$8,144.41 |
| Rate for Payer: Aetna Commercial |
$6,532.50
|
| Rate for Payer: Anthem Medicaid |
$2,917.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,617.33
|
| Rate for Payer: Cash Price |
$4,241.88
|
| Rate for Payer: Cigna Commercial |
$7,041.52
|
| Rate for Payer: First Health Commercial |
$8,059.57
|
| Rate for Payer: Humana Commercial |
$7,211.20
|
| Rate for Payer: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,956.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,261.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,465.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,362.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,787.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,380.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.79
|
| Rate for Payer: PHCS Commercial |
$8,144.41
|
| Rate for Payer: United Healthcare All Payer |
$7,465.71
|
|
