|
RESTORATION GAP RING 52MM
|
Facility
|
OP
|
$13,654.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.06 |
| Max. Negotiated Rate |
$13,108.15 |
| Rate for Payer: Aetna Commercial |
$10,513.83
|
| Rate for Payer: Anthem Medicaid |
$4,695.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.37
|
| Rate for Payer: Cash Price |
$6,827.16
|
| Rate for Payer: Cigna Commercial |
$11,333.09
|
| Rate for Payer: First Health Commercial |
$12,971.60
|
| Rate for Payer: Humana Commercial |
$11,606.17
|
| Rate for Payer: Humana KY Medicaid |
$4,695.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,196.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,076.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,789.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,015.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,240.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,730.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,232.84
|
| Rate for Payer: PHCS Commercial |
$13,108.15
|
| Rate for Payer: United Healthcare All Payer |
$12,015.80
|
|
|
RESTORATION GAP RING 52MM
|
Facility
|
IP
|
$13,654.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.06 |
| Max. Negotiated Rate |
$13,108.15 |
| Rate for Payer: Aetna Commercial |
$10,513.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.37
|
| Rate for Payer: Cash Price |
$6,827.16
|
| Rate for Payer: Cigna Commercial |
$11,333.09
|
| Rate for Payer: First Health Commercial |
$12,971.60
|
| Rate for Payer: Humana Commercial |
$11,606.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,196.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,076.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,015.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,240.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,730.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,232.84
|
| Rate for Payer: PHCS Commercial |
$13,108.15
|
| Rate for Payer: United Healthcare All Payer |
$12,015.80
|
|
|
RESTORATION GAP RING 56MM
|
Facility
|
IP
|
$13,654.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.06 |
| Max. Negotiated Rate |
$13,108.15 |
| Rate for Payer: Aetna Commercial |
$10,513.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.37
|
| Rate for Payer: Cash Price |
$6,827.16
|
| Rate for Payer: Cigna Commercial |
$11,333.09
|
| Rate for Payer: First Health Commercial |
$12,971.60
|
| Rate for Payer: Humana Commercial |
$11,606.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,196.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,076.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,015.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,240.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,730.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,232.84
|
| Rate for Payer: PHCS Commercial |
$13,108.15
|
| Rate for Payer: United Healthcare All Payer |
$12,015.80
|
|
|
RESTORATION GAP RING 56MM
|
Facility
|
OP
|
$13,654.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.06 |
| Max. Negotiated Rate |
$13,108.15 |
| Rate for Payer: Aetna Commercial |
$10,513.83
|
| Rate for Payer: Anthem Medicaid |
$4,695.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.37
|
| Rate for Payer: Cash Price |
$6,827.16
|
| Rate for Payer: Cigna Commercial |
$11,333.09
|
| Rate for Payer: First Health Commercial |
$12,971.60
|
| Rate for Payer: Humana Commercial |
$11,606.17
|
| Rate for Payer: Humana KY Medicaid |
$4,695.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,196.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,076.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,789.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,015.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,240.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,730.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,232.84
|
| Rate for Payer: PHCS Commercial |
$13,108.15
|
| Rate for Payer: United Healthcare All Payer |
$12,015.80
|
|
|
RESTORATION GAP RING 60MM
|
Facility
|
IP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 60MM
|
Facility
|
OP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem Medicaid |
$4,102.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Humana KY Medicaid |
$4,102.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,144.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,184.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 64MM
|
Facility
|
OP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem Medicaid |
$4,102.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Humana KY Medicaid |
$4,102.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,144.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,184.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 64MM
|
Facility
|
IP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 68MM
|
Facility
|
IP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 68MM
|
Facility
|
OP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem Medicaid |
$4,102.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Humana KY Medicaid |
$4,102.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,144.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,184.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 72MM
|
Facility
|
OP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem Medicaid |
$4,102.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Humana KY Medicaid |
$4,102.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,144.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,184.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION GAP RING 72MM
|
Facility
|
IP
|
$11,928.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.72 |
| Max. Negotiated Rate |
$11,451.46 |
| Rate for Payer: Aetna Commercial |
$9,185.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.31
|
| Rate for Payer: Cash Price |
$5,964.30
|
| Rate for Payer: Cigna Commercial |
$9,900.74
|
| Rate for Payer: First Health Commercial |
$11,332.17
|
| Rate for Payer: Humana Commercial |
$10,139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,385.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.87
|
| Rate for Payer: PHCS Commercial |
$11,451.46
|
| Rate for Payer: United Healthcare All Payer |
$10,497.17
|
|
|
RESTORATION MOD HIP STEM 20*15
|
Facility
|
OP
|
$18,299.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.92 |
| Max. Negotiated Rate |
$17,567.42 |
| Rate for Payer: Aetna Commercial |
$14,090.54
|
| Rate for Payer: Anthem Medicaid |
$6,293.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,273.53
|
| Rate for Payer: Cash Price |
$9,149.70
|
| Rate for Payer: Cigna Commercial |
$15,188.50
|
| Rate for Payer: First Health Commercial |
$17,384.43
|
| Rate for Payer: Humana Commercial |
$15,554.49
|
| Rate for Payer: Humana KY Medicaid |
$6,293.16
|
| Rate for Payer: Kentucky WC Medicaid |
$6,357.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,005.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,504.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,489.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,419.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,103.47
|
| Rate for Payer: Ohio Health Group HMO |
$13,724.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,378.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,672.81
|
| Rate for Payer: PHCS Commercial |
$17,567.42
|
| Rate for Payer: United Healthcare All Payer |
$16,103.47
|
|
|
RESTORATION MOD HIP STEM 20*15
|
Facility
|
IP
|
$18,299.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.92 |
| Max. Negotiated Rate |
$17,567.42 |
| Rate for Payer: Aetna Commercial |
$14,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,273.53
|
| Rate for Payer: Cash Price |
$9,149.70
|
| Rate for Payer: Cigna Commercial |
$15,188.50
|
| Rate for Payer: First Health Commercial |
$17,384.43
|
| Rate for Payer: Humana Commercial |
$15,554.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,005.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,504.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,489.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,103.47
|
| Rate for Payer: Ohio Health Group HMO |
$13,724.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,378.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,672.81
|
| Rate for Payer: PHCS Commercial |
$17,567.42
|
| Rate for Payer: United Healthcare All Payer |
$16,103.47
|
|
|
RESTORATION MOD HIP SYS 15MM
|
Facility
|
OP
|
$21,820.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,836.69 |
| Max. Negotiated Rate |
$20,947.85 |
| Rate for Payer: Aetna Commercial |
$16,801.92
|
| Rate for Payer: Anthem Medicaid |
$7,504.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,020.13
|
| Rate for Payer: Cash Price |
$10,910.34
|
| Rate for Payer: Cigna Commercial |
$18,111.16
|
| Rate for Payer: First Health Commercial |
$20,729.65
|
| Rate for Payer: Humana Commercial |
$18,547.58
|
| Rate for Payer: Humana KY Medicaid |
$7,504.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,580.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,103.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,654.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,202.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,365.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,364.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,836.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,764.41
|
| Rate for Payer: PHCS Commercial |
$20,947.85
|
| Rate for Payer: United Healthcare All Payer |
$19,202.20
|
|
|
RESTORATION MOD HIP SYS 15MM
|
Facility
|
IP
|
$21,820.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,836.69 |
| Max. Negotiated Rate |
$20,947.85 |
| Rate for Payer: Aetna Commercial |
$16,801.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,020.13
|
| Rate for Payer: Cash Price |
$10,910.34
|
| Rate for Payer: Cigna Commercial |
$18,111.16
|
| Rate for Payer: First Health Commercial |
$20,729.65
|
| Rate for Payer: Humana Commercial |
$18,547.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,103.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,202.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,365.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,364.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,836.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,764.41
|
| Rate for Payer: PHCS Commercial |
$20,947.85
|
| Rate for Payer: United Healthcare All Payer |
$19,202.20
|
|
|
RESTORATION MOD HIP SYS 17MM
|
Facility
|
IP
|
$21,820.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,836.69 |
| Max. Negotiated Rate |
$20,947.85 |
| Rate for Payer: Aetna Commercial |
$16,801.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,020.13
|
| Rate for Payer: Cash Price |
$10,910.34
|
| Rate for Payer: Cigna Commercial |
$18,111.16
|
| Rate for Payer: First Health Commercial |
$20,729.65
|
| Rate for Payer: Humana Commercial |
$18,547.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,103.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,202.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,365.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,364.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,836.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,764.41
|
| Rate for Payer: PHCS Commercial |
$20,947.85
|
| Rate for Payer: United Healthcare All Payer |
$19,202.20
|
|
|
RESTORATION MOD HIP SYS 17MM
|
Facility
|
OP
|
$21,820.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,836.69 |
| Max. Negotiated Rate |
$20,947.85 |
| Rate for Payer: Aetna Commercial |
$16,801.92
|
| Rate for Payer: Anthem Medicaid |
$7,504.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,020.13
|
| Rate for Payer: Cash Price |
$10,910.34
|
| Rate for Payer: Cigna Commercial |
$18,111.16
|
| Rate for Payer: First Health Commercial |
$20,729.65
|
| Rate for Payer: Humana Commercial |
$18,547.58
|
| Rate for Payer: Humana KY Medicaid |
$7,504.13
|
| Rate for Payer: Kentucky WC Medicaid |
$7,580.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,892.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,103.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,546.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,654.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,202.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,365.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,364.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,836.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,764.41
|
| Rate for Payer: PHCS Commercial |
$20,947.85
|
| Rate for Payer: United Healthcare All Payer |
$19,202.20
|
|
|
RESTORATION MOD HIP SYS 18MM
|
Facility
|
IP
|
$22,544.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,930.83 |
| Max. Negotiated Rate |
$21,643.05 |
| Rate for Payer: Aetna Commercial |
$17,359.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,584.98
|
| Rate for Payer: Cash Price |
$11,272.42
|
| Rate for Payer: Cigna Commercial |
$18,712.22
|
| Rate for Payer: First Health Commercial |
$21,417.60
|
| Rate for Payer: Humana Commercial |
$19,163.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,486.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,638.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,763.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,839.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,908.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,508.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,988.90
|
| Rate for Payer: PHCS Commercial |
$21,643.05
|
| Rate for Payer: United Healthcare All Payer |
$19,839.46
|
|
|
RESTORATION MOD HIP SYS 18MM
|
Facility
|
OP
|
$22,544.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,930.83 |
| Max. Negotiated Rate |
$21,643.05 |
| Rate for Payer: Aetna Commercial |
$17,359.53
|
| Rate for Payer: Anthem Medicaid |
$7,753.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,584.98
|
| Rate for Payer: Cash Price |
$11,272.42
|
| Rate for Payer: Cigna Commercial |
$18,712.22
|
| Rate for Payer: First Health Commercial |
$21,417.60
|
| Rate for Payer: Humana Commercial |
$19,163.11
|
| Rate for Payer: Humana KY Medicaid |
$7,753.17
|
| Rate for Payer: Kentucky WC Medicaid |
$7,832.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,486.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,638.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,763.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,908.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,839.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,908.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,508.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,988.90
|
| Rate for Payer: PHCS Commercial |
$21,643.05
|
| Rate for Payer: United Healthcare All Payer |
$19,839.46
|
|
|
RESTORATION MOD HIP V40 21MM +
|
Facility
|
OP
|
$24,751.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,217.76 |
| Max. Negotiated Rate |
$23,761.91 |
| Rate for Payer: Aetna Commercial |
$19,059.03
|
| Rate for Payer: Anthem Medicaid |
$8,512.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,306.55
|
| Rate for Payer: Cash Price |
$12,376.00
|
| Rate for Payer: Cigna Commercial |
$20,544.15
|
| Rate for Payer: First Health Commercial |
$23,514.39
|
| Rate for Payer: Humana Commercial |
$21,039.19
|
| Rate for Payer: Humana KY Medicaid |
$8,512.21
|
| Rate for Payer: Kentucky WC Medicaid |
$8,598.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,296.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,266.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,425.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,683.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,781.75
|
| Rate for Payer: Ohio Health Group HMO |
$18,563.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,217.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,673.12
|
| Rate for Payer: PHCS Commercial |
$23,761.91
|
| Rate for Payer: United Healthcare All Payer |
$21,781.75
|
|
|
RESTORATION MOD HIP V40 21MM +
|
Facility
|
IP
|
$24,751.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,217.76 |
| Max. Negotiated Rate |
$23,761.91 |
| Rate for Payer: Aetna Commercial |
$19,059.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,306.55
|
| Rate for Payer: Cash Price |
$12,376.00
|
| Rate for Payer: Cigna Commercial |
$20,544.15
|
| Rate for Payer: First Health Commercial |
$23,514.39
|
| Rate for Payer: Humana Commercial |
$21,039.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,296.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,266.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,425.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,781.75
|
| Rate for Payer: Ohio Health Group HMO |
$18,563.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,217.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,673.12
|
| Rate for Payer: PHCS Commercial |
$23,761.91
|
| Rate for Payer: United Healthcare All Payer |
$21,781.75
|
|
|
RESTORATION MOD HIP V40 23MM +
|
Facility
|
OP
|
$24,751.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,217.76 |
| Max. Negotiated Rate |
$23,761.91 |
| Rate for Payer: Aetna Commercial |
$19,059.03
|
| Rate for Payer: Anthem Medicaid |
$8,512.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,306.55
|
| Rate for Payer: Cash Price |
$12,376.00
|
| Rate for Payer: Cigna Commercial |
$20,544.15
|
| Rate for Payer: First Health Commercial |
$23,514.39
|
| Rate for Payer: Humana Commercial |
$21,039.19
|
| Rate for Payer: Humana KY Medicaid |
$8,512.21
|
| Rate for Payer: Kentucky WC Medicaid |
$8,598.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,296.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,266.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,425.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,683.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,781.75
|
| Rate for Payer: Ohio Health Group HMO |
$18,563.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,217.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,673.12
|
| Rate for Payer: PHCS Commercial |
$23,761.91
|
| Rate for Payer: United Healthcare All Payer |
$21,781.75
|
|
|
RESTORATION MOD HIP V40 23MM +
|
Facility
|
IP
|
$24,751.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,217.76 |
| Max. Negotiated Rate |
$23,761.91 |
| Rate for Payer: Aetna Commercial |
$19,059.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,306.55
|
| Rate for Payer: Cash Price |
$12,376.00
|
| Rate for Payer: Cigna Commercial |
$20,544.15
|
| Rate for Payer: First Health Commercial |
$23,514.39
|
| Rate for Payer: Humana Commercial |
$21,039.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,296.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,266.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,425.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,781.75
|
| Rate for Payer: Ohio Health Group HMO |
$18,563.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,217.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,673.12
|
| Rate for Payer: PHCS Commercial |
$23,761.91
|
| Rate for Payer: United Healthcare All Payer |
$21,781.75
|
|
|
RESTORATION MOD PROX 31MM +0
|
Facility
|
OP
|
$18,332.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.18 |
| Max. Negotiated Rate |
$17,598.87 |
| Rate for Payer: Aetna Commercial |
$14,115.76
|
| Rate for Payer: Anthem Medicaid |
$6,304.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,299.08
|
| Rate for Payer: Cash Price |
$9,166.08
|
| Rate for Payer: Cigna Commercial |
$15,215.69
|
| Rate for Payer: First Health Commercial |
$17,415.55
|
| Rate for Payer: Humana Commercial |
$15,582.34
|
| Rate for Payer: Humana KY Medicaid |
$6,304.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,368.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,032.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,529.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,499.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,430.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,132.30
|
| Rate for Payer: Ohio Health Group HMO |
$13,749.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,383.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.97
|
| Rate for Payer: PHCS Commercial |
$17,598.87
|
| Rate for Payer: United Healthcare All Payer |
$16,132.30
|
|
