|
PLUS PROMOS GLENO CENTRIC-42
|
Facility
|
OP
|
$11,081.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.63 |
| Max. Negotiated Rate |
$10,638.53 |
| Rate for Payer: Aetna Commercial |
$8,532.99
|
| Rate for Payer: Anthem Medicaid |
$3,811.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,643.80
|
| Rate for Payer: Cash Price |
$5,540.90
|
| Rate for Payer: Cigna Commercial |
$9,197.89
|
| Rate for Payer: First Health Commercial |
$10,527.71
|
| Rate for Payer: Humana Commercial |
$9,419.53
|
| Rate for Payer: Humana KY Medicaid |
$3,811.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,849.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,087.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,178.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,324.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,887.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,751.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,311.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,435.36
|
| Rate for Payer: PHCS Commercial |
$10,638.53
|
| Rate for Payer: United Healthcare All Payer |
$9,751.98
|
|
|
PLUS PROMOS GLENOID 1-23
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
PLUS PROMOS GLENOID 1-23
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
PLUS PROMOS GLENOID 1-26
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
PLUS PROMOS GLENOID 1-26
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
PLUS PROMOS GLENOID 1-29
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 1-29
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 2-23
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 2-23
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 2-26
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 2-26
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 2-29
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
PLUS PROMOS GLENOID 2-29
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
PLUS PROMOS GLENOID 3-23
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 3-23
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 3-26
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 3-26
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 3-29
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 3-29
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 3-32
|
Facility
|
OP
|
$7,390.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.80 |
| Max. Negotiated Rate |
$7,095.16 |
| Rate for Payer: Aetna Commercial |
$5,690.91
|
| Rate for Payer: Anthem Medicaid |
$2,541.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,764.82
|
| Rate for Payer: Cash Price |
$3,695.39
|
| Rate for Payer: Cigna Commercial |
$6,134.36
|
| Rate for Payer: First Health Commercial |
$7,021.25
|
| Rate for Payer: Humana Commercial |
$6,282.17
|
| Rate for Payer: Humana KY Medicaid |
$2,541.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,060.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,454.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,217.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,503.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,543.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.14
|
| Rate for Payer: PHCS Commercial |
$7,095.16
|
| Rate for Payer: United Healthcare All Payer |
$6,503.90
|
|
|
PLUS PROMOS GLENOID 3-32
|
Facility
|
IP
|
$7,390.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.80 |
| Max. Negotiated Rate |
$7,095.16 |
| Rate for Payer: Aetna Commercial |
$5,690.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,764.82
|
| Rate for Payer: Cash Price |
$3,695.39
|
| Rate for Payer: Cigna Commercial |
$6,134.36
|
| Rate for Payer: First Health Commercial |
$7,021.25
|
| Rate for Payer: Humana Commercial |
$6,282.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,060.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,454.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,217.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,503.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,543.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.14
|
| Rate for Payer: PHCS Commercial |
$7,095.16
|
| Rate for Payer: United Healthcare All Payer |
$6,503.90
|
|
|
PLUS PROMOS GLENOID 4-23
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 4-23
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 4-26
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 4-26
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
