|
BF HUMERAL STEM 8*200
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 9*130
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 9*130
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
B/F HUM HEAD RESECTION GU
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
B/F HUM HEAD RESECTION GU
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
BF HUM STEM 10*200
|
Facility
|
OP
|
$21,503.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.41 |
| Max. Negotiated Rate |
$20,643.00 |
| Rate for Payer: Aetna Commercial |
$16,557.41
|
| Rate for Payer: Anthem Medicaid |
$7,394.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,772.44
|
| Rate for Payer: Cash Price |
$10,751.57
|
| Rate for Payer: Cigna Commercial |
$17,847.60
|
| Rate for Payer: First Health Commercial |
$20,427.97
|
| Rate for Payer: Humana Commercial |
$18,277.66
|
| Rate for Payer: Humana KY Medicaid |
$7,394.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,470.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,632.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,869.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,543.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,127.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.97
|
| Rate for Payer: PHCS Commercial |
$20,643.00
|
| Rate for Payer: United Healthcare All Payer |
$18,922.75
|
|
|
BF HUM STEM 10*200
|
Facility
|
IP
|
$21,503.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.41 |
| Max. Negotiated Rate |
$20,643.00 |
| Rate for Payer: Aetna Commercial |
$16,557.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,772.44
|
| Rate for Payer: Cash Price |
$10,751.57
|
| Rate for Payer: Cigna Commercial |
$17,847.60
|
| Rate for Payer: First Health Commercial |
$20,427.97
|
| Rate for Payer: Humana Commercial |
$18,277.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,632.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,869.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,127.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.97
|
| Rate for Payer: PHCS Commercial |
$20,643.00
|
| Rate for Payer: United Healthcare All Payer |
$18,922.75
|
|
|
BF HUM STEM 12*200
|
Facility
|
OP
|
$21,503.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.41 |
| Max. Negotiated Rate |
$20,643.00 |
| Rate for Payer: Aetna Commercial |
$16,557.41
|
| Rate for Payer: Anthem Medicaid |
$7,394.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,772.44
|
| Rate for Payer: Cash Price |
$10,751.57
|
| Rate for Payer: Cigna Commercial |
$17,847.60
|
| Rate for Payer: First Health Commercial |
$20,427.97
|
| Rate for Payer: Humana Commercial |
$18,277.66
|
| Rate for Payer: Humana KY Medicaid |
$7,394.93
|
| Rate for Payer: Kentucky WC Medicaid |
$7,470.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,632.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,869.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,543.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,127.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.97
|
| Rate for Payer: PHCS Commercial |
$20,643.00
|
| Rate for Payer: United Healthcare All Payer |
$18,922.75
|
|
|
BF HUM STEM 12*200
|
Facility
|
IP
|
$21,503.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.41 |
| Max. Negotiated Rate |
$20,643.00 |
| Rate for Payer: Aetna Commercial |
$16,557.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,772.44
|
| Rate for Payer: Cash Price |
$10,751.57
|
| Rate for Payer: Cigna Commercial |
$17,847.60
|
| Rate for Payer: First Health Commercial |
$20,427.97
|
| Rate for Payer: Humana Commercial |
$18,277.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,632.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,869.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.75
|
| Rate for Payer: Ohio Health Group HMO |
$16,127.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.97
|
| Rate for Payer: PHCS Commercial |
$20,643.00
|
| Rate for Payer: United Healthcare All Payer |
$18,922.75
|
|
|
BF HUM STEM 14*200
|
Facility
|
OP
|
$21,502.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.31 |
| Max. Negotiated Rate |
$20,642.30 |
| Rate for Payer: Aetna Commercial |
$16,556.85
|
| Rate for Payer: Anthem Medicaid |
$7,394.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,771.87
|
| Rate for Payer: Cash Price |
$10,751.20
|
| Rate for Payer: Cigna Commercial |
$17,846.99
|
| Rate for Payer: First Health Commercial |
$20,427.28
|
| Rate for Payer: Humana Commercial |
$18,277.04
|
| Rate for Payer: Humana KY Medicaid |
$7,394.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,469.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,631.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,868.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,543.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$16,126.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.74
|
| Rate for Payer: PHCS Commercial |
$20,642.30
|
| Rate for Payer: United Healthcare All Payer |
$18,922.11
|
|
|
BF HUM STEM 14*200
|
Facility
|
IP
|
$21,502.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.31 |
| Max. Negotiated Rate |
$20,642.30 |
| Rate for Payer: Aetna Commercial |
$16,556.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,771.87
|
| Rate for Payer: Cash Price |
$10,751.20
|
| Rate for Payer: Cigna Commercial |
$17,846.99
|
| Rate for Payer: First Health Commercial |
$20,427.28
|
| Rate for Payer: Humana Commercial |
$18,277.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,631.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,868.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$16,126.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.74
|
| Rate for Payer: PHCS Commercial |
$20,642.30
|
| Rate for Payer: United Healthcare All Payer |
$18,922.11
|
|
|
BF HUM STEM 8*200
|
Facility
|
OP
|
$21,502.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.31 |
| Max. Negotiated Rate |
$20,642.30 |
| Rate for Payer: Aetna Commercial |
$16,556.85
|
| Rate for Payer: Anthem Medicaid |
$7,394.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,771.87
|
| Rate for Payer: Cash Price |
$10,751.20
|
| Rate for Payer: Cigna Commercial |
$17,846.99
|
| Rate for Payer: First Health Commercial |
$20,427.28
|
| Rate for Payer: Humana Commercial |
$18,277.04
|
| Rate for Payer: Humana KY Medicaid |
$7,394.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,469.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,631.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,868.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,543.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$16,126.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.74
|
| Rate for Payer: PHCS Commercial |
$20,642.30
|
| Rate for Payer: United Healthcare All Payer |
$18,922.11
|
|
|
BF HUM STEM 8*200
|
Facility
|
IP
|
$21,502.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,795.31 |
| Max. Negotiated Rate |
$20,642.30 |
| Rate for Payer: Aetna Commercial |
$16,556.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,771.87
|
| Rate for Payer: Cash Price |
$10,751.20
|
| Rate for Payer: Cigna Commercial |
$17,846.99
|
| Rate for Payer: First Health Commercial |
$20,427.28
|
| Rate for Payer: Humana Commercial |
$18,277.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,631.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,868.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,922.11
|
| Rate for Payer: Ohio Health Group HMO |
$16,126.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,665.74
|
| Rate for Payer: PHCS Commercial |
$20,642.30
|
| Rate for Payer: United Healthcare All Payer |
$18,922.11
|
|
|
BF KEELED GLENOID 40MM
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF KEELED GLENOID 40MM
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF KEELED GLENOID 46MM
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF KEELED GLENOID 46MM
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF KEELED GLENOID 52MM
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF KEELED GLENOID 52MM
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
B/F MODULAR HEAD STD IMP SET
|
Facility
|
OP
|
$118,222.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,368.86 |
| Max. Negotiated Rate |
$113,493.12 |
| Rate for Payer: Aetna Commercial |
$91,030.94
|
| Rate for Payer: Anthem Medicaid |
$40,656.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92,213.16
|
| Rate for Payer: Cash Price |
$59,111.00
|
| Rate for Payer: Cigna Commercial |
$98,124.26
|
| Rate for Payer: First Health Commercial |
$112,310.90
|
| Rate for Payer: Humana Commercial |
$100,488.70
|
| Rate for Payer: Humana KY Medicaid |
$40,656.55
|
| Rate for Payer: Kentucky WC Medicaid |
$41,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96,942.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87,247.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,466.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$41,472.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$104,035.36
|
| Rate for Payer: Ohio Health Group HMO |
$88,666.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,644.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,368.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36,648.82
|
| Rate for Payer: PHCS Commercial |
$113,493.12
|
| Rate for Payer: United Healthcare All Payer |
$104,035.36
|
|
|
B/F MODULAR HEAD STD IMP SET
|
Facility
|
IP
|
$118,222.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,368.86 |
| Max. Negotiated Rate |
$113,493.12 |
| Rate for Payer: Aetna Commercial |
$91,030.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92,213.16
|
| Rate for Payer: Cash Price |
$59,111.00
|
| Rate for Payer: Cigna Commercial |
$98,124.26
|
| Rate for Payer: First Health Commercial |
$112,310.90
|
| Rate for Payer: Humana Commercial |
$100,488.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96,942.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87,247.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,466.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$104,035.36
|
| Rate for Payer: Ohio Health Group HMO |
$88,666.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,644.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,368.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36,648.82
|
| Rate for Payer: PHCS Commercial |
$113,493.12
|
| Rate for Payer: United Healthcare All Payer |
$104,035.36
|
|
|
B/F MODULAR STEM MICRO IMP SET
|
Facility
|
OP
|
$72,901.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,477.21 |
| Max. Negotiated Rate |
$69,985.54 |
| Rate for Payer: Aetna Commercial |
$56,134.23
|
| Rate for Payer: Anthem Medicaid |
$25,070.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,863.25
|
| Rate for Payer: Cash Price |
$36,450.80
|
| Rate for Payer: Cigna Commercial |
$60,508.33
|
| Rate for Payer: First Health Commercial |
$69,256.52
|
| Rate for Payer: Humana Commercial |
$61,966.36
|
| Rate for Payer: Humana KY Medicaid |
$25,070.86
|
| Rate for Payer: Kentucky WC Medicaid |
$25,326.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,779.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,801.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,870.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,573.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,153.41
|
| Rate for Payer: Ohio Health Group HMO |
$54,676.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,580.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,477.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,599.50
|
| Rate for Payer: PHCS Commercial |
$69,985.54
|
| Rate for Payer: United Healthcare All Payer |
$64,153.41
|
|
|
B/F MODULAR STEM MICRO IMP SET
|
Facility
|
IP
|
$72,901.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,477.21 |
| Max. Negotiated Rate |
$69,985.54 |
| Rate for Payer: Aetna Commercial |
$56,134.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,863.25
|
| Rate for Payer: Cash Price |
$36,450.80
|
| Rate for Payer: Cigna Commercial |
$60,508.33
|
| Rate for Payer: First Health Commercial |
$69,256.52
|
| Rate for Payer: Humana Commercial |
$61,966.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,779.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,801.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,870.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,153.41
|
| Rate for Payer: Ohio Health Group HMO |
$54,676.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,580.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,477.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,599.50
|
| Rate for Payer: PHCS Commercial |
$69,985.54
|
| Rate for Payer: United Healthcare All Payer |
$64,153.41
|
|
|
B/F MODULAR STEM REV IMP SET
|
Facility
|
OP
|
$95,671.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,437.31 |
| Max. Negotiated Rate |
$91,844.74 |
| Rate for Payer: Aetna Commercial |
$73,667.13
|
| Rate for Payer: Anthem Medicaid |
$32,901.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74,623.85
|
| Rate for Payer: Cash Price |
$47,835.80
|
| Rate for Payer: Cigna Commercial |
$79,407.43
|
| Rate for Payer: First Health Commercial |
$90,888.02
|
| Rate for Payer: Humana Commercial |
$81,320.86
|
| Rate for Payer: Humana KY Medicaid |
$32,901.46
|
| Rate for Payer: Kentucky WC Medicaid |
$33,236.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,450.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,605.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,701.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,561.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$84,191.01
|
| Rate for Payer: Ohio Health Group HMO |
$71,753.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,134.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,437.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,658.20
|
| Rate for Payer: PHCS Commercial |
$91,844.74
|
| Rate for Payer: United Healthcare All Payer |
$84,191.01
|
|
|
B/F MODULAR STEM REV IMP SET
|
Facility
|
IP
|
$95,671.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,437.31 |
| Max. Negotiated Rate |
$91,844.74 |
| Rate for Payer: Aetna Commercial |
$73,667.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74,623.85
|
| Rate for Payer: Cash Price |
$47,835.80
|
| Rate for Payer: Cigna Commercial |
$79,407.43
|
| Rate for Payer: First Health Commercial |
$90,888.02
|
| Rate for Payer: Humana Commercial |
$81,320.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78,450.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70,605.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,701.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$84,191.01
|
| Rate for Payer: Ohio Health Group HMO |
$71,753.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,134.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,437.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,658.20
|
| Rate for Payer: PHCS Commercial |
$91,844.74
|
| Rate for Payer: United Healthcare All Payer |
$84,191.01
|
|
