|
OFFSET HUMERAL HEAD 21X46MM
|
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 HEAD 21X46MM
|
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 21X52MM
|
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 21X52MM
|
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 23X46MM
|
Facility
|
IP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
OFFSET HUMERAL HEAD 23X46MM
|
Facility
|
OP
|
$8,694.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.32 |
| Max. Negotiated Rate |
$8,346.96 |
| Rate for Payer: Aetna Commercial |
$6,694.96
|
| Rate for Payer: Anthem Medicaid |
$2,990.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.90
|
| Rate for Payer: Cash Price |
$4,347.38
|
| Rate for Payer: Cigna Commercial |
$7,216.64
|
| Rate for Payer: First Health Commercial |
$8,260.01
|
| Rate for Payer: Humana Commercial |
$7,390.54
|
| Rate for Payer: Humana KY Medicaid |
$2,990.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,651.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,521.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,738.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.37
|
| Rate for Payer: PHCS Commercial |
$8,346.96
|
| Rate for Payer: United Healthcare All Payer |
$7,651.38
|
|
|
OFFSET HUMERAL HEAD 23X52MM
|
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 23X52MM
|
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 HEAD24X40MM
|
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 HEAD24X40MM
|
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 24X46MM
|
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 24X46MM
|
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 24X52MM
|
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 24X52MM
|
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 27X40MM
|
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 27X40MM
|
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 HEAD27X52MM
|
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 HEAD27X52MM
|
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 30X46MM
|
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 30X46MM
|
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 30X52MM
|
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 30X52MM
|
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 33X52 MM
|
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 33X52 MM
|
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 HUM HEAD 15X40MM
|
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
|
|
