|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
51000331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
51000331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$121.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$340.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$272.23
|
| Rate for Payer: Healthspan PPO |
$214.87
|
| Rate for Payer: Humana Medicaid |
$121.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.80
|
| Rate for Payer: Molina Healthcare Passport |
$121.37
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: United Healthcare Non-Options |
$199.07
|
| Rate for Payer: United Healthcare Options |
$137.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.58
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
510P0331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$272.23 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.31
|
| Rate for Payer: Anthem Medicaid |
$121.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$272.23
|
| Rate for Payer: Healthspan PPO |
$214.87
|
| Rate for Payer: Humana Medicaid |
$121.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.80
|
| Rate for Payer: Molina Healthcare Passport |
$121.37
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$80.13
|
| Rate for Payer: United Healthcare Non-Options |
$199.07
|
| Rate for Payer: United Healthcare Options |
$137.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.58
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40(T
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
510T0331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OFF/OP CNSLTJ NEW/EST MOD 40(T
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 99244
|
| Hospital Charge Code |
510T0331
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
51000332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Anthem Medicaid |
$196.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.60
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$473.10
|
| Rate for Payer: First Health Commercial |
$541.50
|
| Rate for Payer: Humana Commercial |
$484.50
|
| Rate for Payer: Humana KY Medicaid |
$196.02
|
| Rate for Payer: Kentucky WC Medicaid |
$198.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.60
|
| Rate for Payer: Ohio Health Group HMO |
$427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.70
|
| Rate for Payer: PHCS Commercial |
$547.20
|
| Rate for Payer: United Healthcare All Payer |
$501.60
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
51000332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$547.20 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.60
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$473.10
|
| Rate for Payer: First Health Commercial |
$541.50
|
| Rate for Payer: Humana Commercial |
$484.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.60
|
| Rate for Payer: Ohio Health Group HMO |
$427.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.70
|
| Rate for Payer: PHCS Commercial |
$547.20
|
| Rate for Payer: United Healthcare All Payer |
$501.60
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
51000332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.48 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$304.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.48
|
| Rate for Payer: Anthem Medicaid |
$150.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$570.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cash Price |
$285.00
|
| Rate for Payer: Cigna Commercial |
$337.77
|
| Rate for Payer: Healthspan PPO |
$264.42
|
| Rate for Payer: Humana Medicaid |
$150.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.76
|
| Rate for Payer: Molina Healthcare Passport |
$150.75
|
| Rate for Payer: Multiplan PHCS |
$342.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$399.00
|
| Rate for Payer: UHCCP Medicaid |
$99.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$152.26
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
510P0332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.48 |
| Max. Negotiated Rate |
$337.77 |
| Rate for Payer: Aetna Commercial |
$304.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.48
|
| Rate for Payer: Anthem Medicaid |
$150.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$337.77
|
| Rate for Payer: Healthspan PPO |
$264.42
|
| Rate for Payer: Humana Medicaid |
$150.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.76
|
| Rate for Payer: Molina Healthcare Passport |
$150.75
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$99.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$152.26
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55(T
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
510T0332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$118.65
|
| Rate for Payer: Kentucky WC Medicaid |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
OFF/OP CONSLTJ NEW/EST HI 55(T
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 99245
|
| Hospital Charge Code |
510T0332
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 99242
|
| Hospital Charge Code |
51000329
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$135.01 |
| Rate for Payer: Aetna Commercial |
$111.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.92
|
| Rate for Payer: Anthem Medicaid |
$54.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$135.01
|
| Rate for Payer: Healthspan PPO |
$105.77
|
| Rate for Payer: Humana Medicaid |
$54.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.01
|
| Rate for Payer: Molina Healthcare Passport |
$54.91
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$35.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.46
|
|
|
OFF/OP CONSLTJ NEW/EST SF 20(P
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 99242
|
| Hospital Charge Code |
510P0329
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$135.01 |
| Rate for Payer: Aetna Commercial |
$111.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.92
|
| Rate for Payer: Anthem Medicaid |
$54.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.00
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$135.01
|
| Rate for Payer: Healthspan PPO |
$105.77
|
| Rate for Payer: Humana Medicaid |
$54.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.01
|
| Rate for Payer: Molina Healthcare Passport |
$54.91
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$35.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.46
|
|
|
OFFSET HUMERAL HEAD 17X46MM
|
Facility
|
IP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD 17X46MM
|
Facility
|
OP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem Medicaid |
$3,734.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Humana KY Medicaid |
$3,734.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,772.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,809.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD 18X40MM
|
Facility
|
IP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD 18X40MM
|
Facility
|
OP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem Medicaid |
$3,734.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Humana KY Medicaid |
$3,734.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,772.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,809.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD 18X46MM
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
OFFSET HUMERAL HEAD 18X46MM
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
OFFSET HUMERAL HEAD 18X52MM
|
Facility
|
IP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD 18X52MM
|
Facility
|
OP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem Medicaid |
$3,734.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Humana KY Medicaid |
$3,734.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,772.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,809.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD19X46MM
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
OFFSET HUMERAL HEAD19X46MM
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
OFFSET HUMERAL HEAD 21X40MM
|
Facility
|
OP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem Medicaid |
$3,734.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Humana KY Medicaid |
$3,734.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,772.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,809.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
|
OFFSET HUMERAL HEAD 21X40MM
|
Facility
|
IP
|
$10,859.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$10,424.78 |
| Rate for Payer: Aetna Commercial |
$8,361.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.14
|
| Rate for Payer: Cash Price |
$5,429.58
|
| Rate for Payer: Cigna Commercial |
$9,013.09
|
| Rate for Payer: First Health Commercial |
$10,316.19
|
| Rate for Payer: Humana Commercial |
$9,230.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,904.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,257.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,144.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,366.34
|
| Rate for Payer: PHCS Commercial |
$10,424.78
|
| Rate for Payer: United Healthcare All Payer |
$9,556.05
|
|
