|
PLUS PROMOS GLENOID 3-23
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 3-26
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 3-26
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 3-29
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 3-29
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 3-32
|
Facility
|
IP
|
$7,590.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.24 |
| Max. Negotiated Rate |
$7,287.16 |
| Rate for Payer: Aetna Commercial |
$5,844.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,920.82
|
| Rate for Payer: Cash Price |
$3,795.39
|
| Rate for Payer: Cigna Commercial |
$6,300.36
|
| Rate for Payer: First Health Commercial |
$7,211.25
|
| Rate for Payer: Humana Commercial |
$6,452.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,224.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,602.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,679.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,693.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,072.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,603.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,237.65
|
| Rate for Payer: PHCS Commercial |
$7,287.16
|
| Rate for Payer: United Healthcare All Payer |
$6,679.90
|
|
|
PLUS PROMOS GLENOID 3-32
|
Facility
|
OP
|
$7,590.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.24 |
| Max. Negotiated Rate |
$7,287.16 |
| Rate for Payer: Aetna Commercial |
$5,844.91
|
| Rate for Payer: Anthem Medicaid |
$2,610.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,920.82
|
| Rate for Payer: Cash Price |
$3,795.39
|
| Rate for Payer: Cigna Commercial |
$6,300.36
|
| Rate for Payer: First Health Commercial |
$7,211.25
|
| Rate for Payer: Humana Commercial |
$6,452.17
|
| Rate for Payer: Humana KY Medicaid |
$2,610.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,637.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,224.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,602.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,277.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,679.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,693.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,072.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,603.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,237.65
|
| Rate for Payer: PHCS Commercial |
$7,287.16
|
| Rate for Payer: United Healthcare All Payer |
$6,679.90
|
|
|
PLUS PROMOS GLENOID 4-23
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 4-23
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 4-26
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 4-26
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 4-29
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID 4-29
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLUS PROMOS GLENOID BASE PLATE
|
Facility
|
IP
|
$11,324.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,397.33 |
| Max. Negotiated Rate |
$10,871.46 |
| Rate for Payer: Aetna Commercial |
$8,719.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,833.06
|
| Rate for Payer: Cash Price |
$5,662.22
|
| Rate for Payer: Cigna Commercial |
$9,399.29
|
| Rate for Payer: First Health Commercial |
$10,758.22
|
| Rate for Payer: Humana Commercial |
$9,625.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,286.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,357.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,397.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,965.51
|
| Rate for Payer: Ohio Health Group HMO |
$8,493.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,059.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,852.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,813.86
|
| Rate for Payer: PHCS Commercial |
$10,871.46
|
| Rate for Payer: United Healthcare All Payer |
$9,965.51
|
|
|
PLUS PROMOS GLENOID BASE PLATE
|
Facility
|
OP
|
$11,324.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,397.33 |
| Max. Negotiated Rate |
$10,871.46 |
| Rate for Payer: Aetna Commercial |
$8,719.82
|
| Rate for Payer: Anthem Medicaid |
$3,894.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,833.06
|
| Rate for Payer: Cash Price |
$5,662.22
|
| Rate for Payer: Cigna Commercial |
$9,399.29
|
| Rate for Payer: First Health Commercial |
$10,758.22
|
| Rate for Payer: Humana Commercial |
$9,625.77
|
| Rate for Payer: Humana KY Medicaid |
$3,894.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,286.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,357.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,397.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,972.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,965.51
|
| Rate for Payer: Ohio Health Group HMO |
$8,493.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,059.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,852.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,813.86
|
| Rate for Payer: PHCS Commercial |
$10,871.46
|
| Rate for Payer: United Healthcare All Payer |
$9,965.51
|
|
|
PLUS PROMOS HUMERAL HD R 19/+2
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUMERAL HD R 19/+2
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUMERAL HD R 20/+4
|
Facility
|
OP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem Medicaid |
$3,064.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Humana KY Medicaid |
$3,064.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,095.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,125.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUMERAL HD R 20/+4
|
Facility
|
IP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUMERAL HD R 21/+5
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUMERAL HD R 21/+5
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 21/H17+4
|
Facility
|
IP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUM HD R 21/H17+4
|
Facility
|
OP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem Medicaid |
$3,064.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Humana KY Medicaid |
$3,064.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,095.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,125.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUM HD R22/ H17+6
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R22/ H17+6
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
