|
MOD HEAD 2MM HEMI HEAD 52MM
|
Facility
|
OP
|
$17,844.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.72 |
| Max. Negotiated Rate |
$17,130.24 |
| Rate for Payer: Aetna Commercial |
$13,739.88
|
| Rate for Payer: Anthem Medicaid |
$6,136.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,918.32
|
| Rate for Payer: Cash Price |
$8,922.00
|
| Rate for Payer: Cigna Commercial |
$14,810.52
|
| Rate for Payer: First Health Commercial |
$16,951.80
|
| Rate for Payer: Humana Commercial |
$15,167.40
|
| Rate for Payer: Humana KY Medicaid |
$6,136.55
|
| Rate for Payer: Kentucky WC Medicaid |
$6,199.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,632.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,168.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,353.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,259.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,702.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,319.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,531.64
|
| Rate for Payer: PHCS Commercial |
$17,130.24
|
| Rate for Payer: United Healthcare All Payer |
$15,702.72
|
|
|
MOD HEAD 2MM HEMI HEAD 52MM
|
Facility
|
IP
|
$17,844.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.72 |
| Max. Negotiated Rate |
$17,130.24 |
| Rate for Payer: Aetna Commercial |
$13,739.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,918.32
|
| Rate for Payer: Cash Price |
$8,922.00
|
| Rate for Payer: Cigna Commercial |
$14,810.52
|
| Rate for Payer: First Health Commercial |
$16,951.80
|
| Rate for Payer: Humana Commercial |
$15,167.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,632.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,168.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,353.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,702.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,319.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,531.64
|
| Rate for Payer: PHCS Commercial |
$17,130.24
|
| Rate for Payer: United Healthcare All Payer |
$15,702.72
|
|
|
MOD HEAD 2MM HEMI HEAD 56MM
|
Facility
|
IP
|
$17,844.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.72 |
| Max. Negotiated Rate |
$17,130.24 |
| Rate for Payer: Aetna Commercial |
$13,739.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,918.32
|
| Rate for Payer: Cash Price |
$8,922.00
|
| Rate for Payer: Cigna Commercial |
$14,810.52
|
| Rate for Payer: First Health Commercial |
$16,951.80
|
| Rate for Payer: Humana Commercial |
$15,167.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,632.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,168.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,353.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,702.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,319.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,531.64
|
| Rate for Payer: PHCS Commercial |
$17,130.24
|
| Rate for Payer: United Healthcare All Payer |
$15,702.72
|
|
|
MOD HEAD 2MM HEMI HEAD 56MM
|
Facility
|
OP
|
$17,844.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.72 |
| Max. Negotiated Rate |
$17,130.24 |
| Rate for Payer: Aetna Commercial |
$13,739.88
|
| Rate for Payer: Anthem Medicaid |
$6,136.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,918.32
|
| Rate for Payer: Cash Price |
$8,922.00
|
| Rate for Payer: Cigna Commercial |
$14,810.52
|
| Rate for Payer: First Health Commercial |
$16,951.80
|
| Rate for Payer: Humana Commercial |
$15,167.40
|
| Rate for Payer: Humana KY Medicaid |
$6,136.55
|
| Rate for Payer: Kentucky WC Medicaid |
$6,199.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,632.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,168.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,353.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,259.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,702.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,319.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,531.64
|
| Rate for Payer: PHCS Commercial |
$17,130.24
|
| Rate for Payer: United Healthcare All Payer |
$15,702.72
|
|
|
MOD HEAD COMP 28MM +12
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
MOD HEAD COMP 28MM +12
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
MOD HEAD COMP 28MM +3
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
MOD HEAD COMP 28MM +3
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
MOD HEAD COMP 28MM -3
|
Facility
|
OP
|
$4,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.87 |
| Max. Negotiated Rate |
$4,511.04 |
| Rate for Payer: Aetna Commercial |
$3,618.23
|
| Rate for Payer: Anthem Medicaid |
$1,615.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,665.22
|
| Rate for Payer: Cash Price |
$2,349.50
|
| Rate for Payer: Cigna Commercial |
$3,900.17
|
| Rate for Payer: First Health Commercial |
$4,464.05
|
| Rate for Payer: Humana Commercial |
$3,994.15
|
| Rate for Payer: Humana KY Medicaid |
$1,615.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,853.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,135.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,524.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.69
|
| Rate for Payer: PHCS Commercial |
$4,511.04
|
| Rate for Payer: United Healthcare All Payer |
$4,135.12
|
|
|
MOD HEAD COMP 28MM -3
|
Facility
|
IP
|
$4,699.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.87 |
| Max. Negotiated Rate |
$4,511.04 |
| Rate for Payer: Aetna Commercial |
$3,618.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,665.22
|
| Rate for Payer: Cash Price |
$2,349.50
|
| Rate for Payer: Cigna Commercial |
$3,900.17
|
| Rate for Payer: First Health Commercial |
$4,464.05
|
| Rate for Payer: Humana Commercial |
$3,994.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,853.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,135.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,524.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.69
|
| Rate for Payer: PHCS Commercial |
$4,511.04
|
| Rate for Payer: United Healthcare All Payer |
$4,135.12
|
|
|
MOD HEAD COMP 28MM +9
|
Facility
|
IP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 28MM +9
|
Facility
|
OP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem Medicaid |
$1,552.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Humana KY Medicaid |
$1,552.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,567.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 28MM STD
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
MOD HEAD COMP 28MM STD
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
MOD HEAD COMP 32MM -3
|
Facility
|
IP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 32MM -3
|
Facility
|
OP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem Medicaid |
$1,552.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Humana KY Medicaid |
$1,552.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,567.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 32MM -6
|
Facility
|
IP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 32MM -6
|
Facility
|
OP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem Medicaid |
$1,552.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Humana KY Medicaid |
$1,552.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,567.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 32MM STD
|
Facility
|
IP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD HEAD COMP 32MM STD
|
Facility
|
OP
|
$4,513.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.76 |
| Max. Negotiated Rate |
$4,332.96 |
| Rate for Payer: Aetna Commercial |
$3,475.40
|
| Rate for Payer: Anthem Medicaid |
$1,552.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.53
|
| Rate for Payer: Cash Price |
$2,256.75
|
| Rate for Payer: Cigna Commercial |
$3,746.20
|
| Rate for Payer: First Health Commercial |
$4,287.82
|
| Rate for Payer: Humana Commercial |
$3,836.48
|
| Rate for Payer: Humana KY Medicaid |
$1,552.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,567.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,330.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.18
|
| Rate for Payer: PHCS Commercial |
$4,332.96
|
| Rate for Payer: United Healthcare All Payer |
$3,971.88
|
|
|
MOD ROTATING HINGE KNEE AXLE
|
Facility
|
OP
|
$7,248.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.27 |
| Max. Negotiated Rate |
$6,958.33 |
| Rate for Payer: Aetna Commercial |
$5,581.16
|
| Rate for Payer: Anthem Medicaid |
$2,492.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,653.64
|
| Rate for Payer: Cash Price |
$3,624.13
|
| Rate for Payer: Cigna Commercial |
$6,016.06
|
| Rate for Payer: First Health Commercial |
$6,885.85
|
| Rate for Payer: Humana Commercial |
$6,161.02
|
| Rate for Payer: Humana KY Medicaid |
$2,492.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,518.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,943.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,349.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,542.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,378.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,436.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,246.96
|
| Rate for Payer: PHCS Commercial |
$6,958.33
|
| Rate for Payer: United Healthcare All Payer |
$6,378.47
|
|
|
MOD ROTATING HINGE KNEE AXLE
|
Facility
|
IP
|
$7,248.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.27 |
| Max. Negotiated Rate |
$6,958.33 |
| Rate for Payer: Aetna Commercial |
$5,581.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,653.64
|
| Rate for Payer: Cash Price |
$3,624.13
|
| Rate for Payer: Cigna Commercial |
$6,016.06
|
| Rate for Payer: First Health Commercial |
$6,885.85
|
| Rate for Payer: Humana Commercial |
$6,161.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,943.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,349.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,378.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,436.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,246.96
|
| Rate for Payer: PHCS Commercial |
$6,958.33
|
| Rate for Payer: United Healthcare All Payer |
$6,378.47
|
|
|
MOD ROTATING HINGE KNEE LG LT
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE LG LT
|
Facility
|
OP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem Medicaid |
$7,148.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Humana KY Medicaid |
$7,148.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,221.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,292.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE LG RT
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
