|
OFFSET HUMERAL HEAD 24X46MM
|
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 24X46MM
|
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 24X52MM
|
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 24X52MM
|
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 27X40MM
|
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 27X40MM
|
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 HEAD27X52MM
|
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 HEAD27X52MM
|
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 30X46MM
|
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 30X46MM
|
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 30X52MM
|
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 30X52MM
|
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 33X52 MM
|
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 33X52 MM
|
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 HUM HEAD 15X40MM
|
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 HUM HEAD 15X40MM
|
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 HUM HEAD 15X46MM
|
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 HUM HEAD 15X46MM
|
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 HUMMERAL HEAD 27X46MM
|
Facility
|
OP
|
$8,919.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.96 |
| Max. Negotiated Rate |
$8,563.07 |
| Rate for Payer: Aetna Commercial |
$6,868.29
|
| Rate for Payer: Anthem Medicaid |
$3,067.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.49
|
| Rate for Payer: Cash Price |
$4,459.93
|
| Rate for Payer: Cigna Commercial |
$7,403.48
|
| Rate for Payer: First Health Commercial |
$8,473.87
|
| Rate for Payer: Humana Commercial |
$7,581.88
|
| Rate for Payer: Humana KY Medicaid |
$3,067.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,098.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,314.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,760.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.70
|
| Rate for Payer: PHCS Commercial |
$8,563.07
|
| Rate for Payer: United Healthcare All Payer |
$7,849.48
|
|
|
OFFSET HUMMERAL HEAD 27X46MM
|
Facility
|
IP
|
$8,919.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.96 |
| Max. Negotiated Rate |
$8,563.07 |
| Rate for Payer: Aetna Commercial |
$6,868.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.49
|
| Rate for Payer: Cash Price |
$4,459.93
|
| Rate for Payer: Cigna Commercial |
$7,403.48
|
| Rate for Payer: First Health Commercial |
$8,473.87
|
| Rate for Payer: Humana Commercial |
$7,581.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,314.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,760.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.70
|
| Rate for Payer: PHCS Commercial |
$8,563.07
|
| Rate for Payer: United Healthcare All Payer |
$7,849.48
|
|
|
OFFSET STD TPR LCK 133*9.0 PPS
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
OFFSET STD TPR LCK 133*9.0 PPS
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
OFFSET TPR LCK 133*10.0 PPS
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
OFFSET TPR LCK 133*10.0 PPS
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
OFFSET TPR LCK 133*11.0 PPS
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
