|
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 |
$103.50 |
| 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 |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| 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 |
$67.83
|
| 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 |
$67.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.19
|
| Rate for Payer: Molina Healthcare Passport |
$67.83
|
| 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 |
$68.51
|
|
|
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 |
$67.83
|
| 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 |
$67.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.19
|
| Rate for Payer: Molina Healthcare Passport |
$67.83
|
| 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 |
$68.51
|
|
|
OFFSET HUMERAL HEAD 17X46MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 17X46MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 18X40MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 18X40MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 18X46MM
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
OFFSET HUMERAL HEAD 18X46MM
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
OFFSET HUMERAL HEAD 18X52MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 18X52MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD19X46MM
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
OFFSET HUMERAL HEAD19X46MM
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
OFFSET HUMERAL HEAD 21X40MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 21X40MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 21X46MM
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
OFFSET HUMERAL HEAD 21X46MM
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
OFFSET HUMERAL HEAD 21X52MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 21X52MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 23X46MM
|
Facility
|
OP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem Medicaid |
$3,058.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Humana KY Medicaid |
$3,058.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,090.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,120.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
OFFSET HUMERAL HEAD 23X46MM
|
Facility
|
IP
|
$8,894.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,668.43 |
| Max. Negotiated Rate |
$8,538.96 |
| Rate for Payer: Aetna Commercial |
$6,848.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,937.90
|
| Rate for Payer: Cash Price |
$4,447.38
|
| Rate for Payer: Cigna Commercial |
$7,382.64
|
| Rate for Payer: First Health Commercial |
$8,450.01
|
| Rate for Payer: Humana Commercial |
$7,560.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,293.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,564.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,668.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,827.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,671.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,738.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,137.38
|
| Rate for Payer: PHCS Commercial |
$8,538.96
|
| Rate for Payer: United Healthcare All Payer |
$7,827.38
|
|
|
OFFSET HUMERAL HEAD 23X52MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD 23X52MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD24X40MM
|
Facility
|
IP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
|
OFFSET HUMERAL HEAD24X40MM
|
Facility
|
OP
|
$11,100.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.17 |
| Max. Negotiated Rate |
$10,656.55 |
| Rate for Payer: Aetna Commercial |
$8,547.44
|
| Rate for Payer: Anthem Medicaid |
$3,817.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,658.44
|
| Rate for Payer: Cash Price |
$5,550.28
|
| Rate for Payer: Cigna Commercial |
$9,213.47
|
| Rate for Payer: First Health Commercial |
$10,545.54
|
| Rate for Payer: Humana Commercial |
$9,435.48
|
| Rate for Payer: Humana KY Medicaid |
$3,817.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,856.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,102.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,192.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,330.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,768.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,325.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,880.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,659.39
|
| Rate for Payer: PHCS Commercial |
$10,656.55
|
| Rate for Payer: United Healthcare All Payer |
$9,768.50
|
|
