|
RESTORATION GAP RING 56MM
|
Facility
|
IP
|
$13,911.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,173.32 |
| Max. Negotiated Rate |
$13,354.62 |
| Rate for Payer: Aetna Commercial |
$10,711.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,850.63
|
| Rate for Payer: Cash Price |
$6,955.53
|
| Rate for Payer: Cigna Commercial |
$11,546.18
|
| Rate for Payer: First Health Commercial |
$13,215.51
|
| Rate for Payer: Humana Commercial |
$11,824.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,407.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,266.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,173.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,241.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,433.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,128.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,102.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,598.63
|
| Rate for Payer: PHCS Commercial |
$13,354.62
|
| Rate for Payer: United Healthcare All Payer |
$12,241.73
|
|
|
RESTORATION GAP RING 56MM
|
Facility
|
OP
|
$13,911.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,173.32 |
| Max. Negotiated Rate |
$13,354.62 |
| Rate for Payer: Aetna Commercial |
$10,711.52
|
| Rate for Payer: Anthem Medicaid |
$4,784.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,850.63
|
| Rate for Payer: Cash Price |
$6,955.53
|
| Rate for Payer: Cigna Commercial |
$11,546.18
|
| Rate for Payer: First Health Commercial |
$13,215.51
|
| Rate for Payer: Humana Commercial |
$11,824.40
|
| Rate for Payer: Humana KY Medicaid |
$4,784.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,832.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,407.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,266.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,173.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,880.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,241.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,433.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,128.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,102.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,598.63
|
| Rate for Payer: PHCS Commercial |
$13,354.62
|
| Rate for Payer: United Healthcare All Payer |
$12,241.73
|
|
|
RESTORATION GAP RING 60MM
|
Facility
|
IP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 60MM
|
Facility
|
OP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem Medicaid |
$4,187.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Humana KY Medicaid |
$4,187.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,229.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,271.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 64MM
|
Facility
|
OP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem Medicaid |
$4,187.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Humana KY Medicaid |
$4,187.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,229.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,271.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 64MM
|
Facility
|
IP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 68MM
|
Facility
|
OP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem Medicaid |
$4,187.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Humana KY Medicaid |
$4,187.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,229.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,271.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 68MM
|
Facility
|
IP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 72MM
|
Facility
|
OP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem Medicaid |
$4,187.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Humana KY Medicaid |
$4,187.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,229.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,271.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION GAP RING 72MM
|
Facility
|
IP
|
$12,175.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,652.76 |
| Max. Negotiated Rate |
$11,688.84 |
| Rate for Payer: Aetna Commercial |
$9,375.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,497.19
|
| Rate for Payer: Cash Price |
$6,087.94
|
| Rate for Payer: Cigna Commercial |
$10,105.98
|
| Rate for Payer: First Health Commercial |
$11,567.09
|
| Rate for Payer: Humana Commercial |
$10,349.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,984.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,985.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,652.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,714.77
|
| Rate for Payer: Ohio Health Group HMO |
$9,131.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,740.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,593.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,401.36
|
| Rate for Payer: PHCS Commercial |
$11,688.84
|
| Rate for Payer: United Healthcare All Payer |
$10,714.77
|
|
|
RESTORATION MOD HIP STEM 20*15
|
Facility
|
OP
|
$18,891.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,667.31 |
| Max. Negotiated Rate |
$18,135.41 |
| Rate for Payer: Aetna Commercial |
$14,546.11
|
| Rate for Payer: Anthem Medicaid |
$6,496.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,735.02
|
| Rate for Payer: Cash Price |
$9,445.52
|
| Rate for Payer: Cigna Commercial |
$15,679.57
|
| Rate for Payer: First Health Commercial |
$17,946.50
|
| Rate for Payer: Humana Commercial |
$16,057.39
|
| Rate for Payer: Humana KY Medicaid |
$6,496.63
|
| Rate for Payer: Kentucky WC Medicaid |
$6,562.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,941.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,667.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,626.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,624.12
|
| Rate for Payer: Ohio Health Group HMO |
$14,168.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,112.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,435.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,034.82
|
| Rate for Payer: PHCS Commercial |
$18,135.41
|
| Rate for Payer: United Healthcare All Payer |
$16,624.12
|
|
|
RESTORATION MOD HIP STEM 20*15
|
Facility
|
IP
|
$18,891.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,667.31 |
| Max. Negotiated Rate |
$18,135.41 |
| Rate for Payer: Aetna Commercial |
$14,546.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,735.02
|
| Rate for Payer: Cash Price |
$9,445.52
|
| Rate for Payer: Cigna Commercial |
$15,679.57
|
| Rate for Payer: First Health Commercial |
$17,946.50
|
| Rate for Payer: Humana Commercial |
$16,057.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,490.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,941.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,667.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,624.12
|
| Rate for Payer: Ohio Health Group HMO |
$14,168.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,112.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,435.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,034.82
|
| Rate for Payer: PHCS Commercial |
$18,135.41
|
| Rate for Payer: United Healthcare All Payer |
$16,624.12
|
|
|
RESTORATION MOD HIP SYS 15MM
|
Facility
|
IP
|
$22,487.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,746.10 |
| Max. Negotiated Rate |
$21,587.52 |
| Rate for Payer: Aetna Commercial |
$17,314.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,539.86
|
| Rate for Payer: Cash Price |
$11,243.50
|
| Rate for Payer: Cigna Commercial |
$18,664.21
|
| Rate for Payer: First Health Commercial |
$21,362.65
|
| Rate for Payer: Humana Commercial |
$19,113.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,439.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,595.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,746.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,788.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,865.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,563.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,516.03
|
| Rate for Payer: PHCS Commercial |
$21,587.52
|
| Rate for Payer: United Healthcare All Payer |
$19,788.56
|
|
|
RESTORATION MOD HIP SYS 15MM
|
Facility
|
OP
|
$22,487.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,746.10 |
| Max. Negotiated Rate |
$21,587.52 |
| Rate for Payer: Aetna Commercial |
$17,314.99
|
| Rate for Payer: Anthem Medicaid |
$7,733.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,539.86
|
| Rate for Payer: Cash Price |
$11,243.50
|
| Rate for Payer: Cigna Commercial |
$18,664.21
|
| Rate for Payer: First Health Commercial |
$21,362.65
|
| Rate for Payer: Humana Commercial |
$19,113.95
|
| Rate for Payer: Humana KY Medicaid |
$7,733.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,811.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,439.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,595.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,746.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,888.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,788.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,865.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,563.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,516.03
|
| Rate for Payer: PHCS Commercial |
$21,587.52
|
| Rate for Payer: United Healthcare All Payer |
$19,788.56
|
|
|
RESTORATION MOD HIP SYS 17MM
|
Facility
|
OP
|
$22,487.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,746.10 |
| Max. Negotiated Rate |
$21,587.52 |
| Rate for Payer: Aetna Commercial |
$17,314.99
|
| Rate for Payer: Anthem Medicaid |
$7,733.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,539.86
|
| Rate for Payer: Cash Price |
$11,243.50
|
| Rate for Payer: Cigna Commercial |
$18,664.21
|
| Rate for Payer: First Health Commercial |
$21,362.65
|
| Rate for Payer: Humana Commercial |
$19,113.95
|
| Rate for Payer: Humana KY Medicaid |
$7,733.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,811.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,439.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,595.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,746.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,888.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,788.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,865.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,563.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,516.03
|
| Rate for Payer: PHCS Commercial |
$21,587.52
|
| Rate for Payer: United Healthcare All Payer |
$19,788.56
|
|
|
RESTORATION MOD HIP SYS 17MM
|
Facility
|
IP
|
$22,487.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,746.10 |
| Max. Negotiated Rate |
$21,587.52 |
| Rate for Payer: Aetna Commercial |
$17,314.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,539.86
|
| Rate for Payer: Cash Price |
$11,243.50
|
| Rate for Payer: Cigna Commercial |
$18,664.21
|
| Rate for Payer: First Health Commercial |
$21,362.65
|
| Rate for Payer: Humana Commercial |
$19,113.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,439.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,595.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,746.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,788.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,865.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,989.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,563.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,516.03
|
| Rate for Payer: PHCS Commercial |
$21,587.52
|
| Rate for Payer: United Healthcare All Payer |
$19,788.56
|
|
|
RESTORATION MOD HIP SYS 18MM
|
Facility
|
IP
|
$23,231.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,969.30 |
| Max. Negotiated Rate |
$22,301.76 |
| Rate for Payer: Aetna Commercial |
$17,887.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,120.18
|
| Rate for Payer: Cash Price |
$11,615.50
|
| Rate for Payer: Cigna Commercial |
$19,281.73
|
| Rate for Payer: First Health Commercial |
$22,069.45
|
| Rate for Payer: Humana Commercial |
$19,746.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,049.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,144.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,969.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,443.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,423.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,210.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,029.39
|
| Rate for Payer: PHCS Commercial |
$22,301.76
|
| Rate for Payer: United Healthcare All Payer |
$20,443.28
|
|
|
RESTORATION MOD HIP SYS 18MM
|
Facility
|
OP
|
$23,231.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,969.30 |
| Max. Negotiated Rate |
$22,301.76 |
| Rate for Payer: Aetna Commercial |
$17,887.87
|
| Rate for Payer: Anthem Medicaid |
$7,989.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,120.18
|
| Rate for Payer: Cash Price |
$11,615.50
|
| Rate for Payer: Cigna Commercial |
$19,281.73
|
| Rate for Payer: First Health Commercial |
$22,069.45
|
| Rate for Payer: Humana Commercial |
$19,746.35
|
| Rate for Payer: Humana KY Medicaid |
$7,989.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,070.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,049.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,144.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,969.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,149.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,443.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,423.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,210.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,029.39
|
| Rate for Payer: PHCS Commercial |
$22,301.76
|
| Rate for Payer: United Healthcare All Payer |
$20,443.28
|
|
|
RESTORATION MOD HIP V40 21MM +
|
Facility
|
OP
|
$25,498.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,649.59 |
| Max. Negotiated Rate |
$24,478.68 |
| Rate for Payer: Aetna Commercial |
$19,633.94
|
| Rate for Payer: Anthem Medicaid |
$8,768.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,888.92
|
| Rate for Payer: Cash Price |
$12,749.31
|
| Rate for Payer: Cigna Commercial |
$21,163.85
|
| Rate for Payer: First Health Commercial |
$24,223.69
|
| Rate for Payer: Humana Commercial |
$21,673.83
|
| Rate for Payer: Humana KY Medicaid |
$8,768.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,858.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,908.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,817.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,649.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,944.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,438.79
|
| Rate for Payer: Ohio Health Group HMO |
$19,123.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,398.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,183.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,594.05
|
| Rate for Payer: PHCS Commercial |
$24,478.68
|
| Rate for Payer: United Healthcare All Payer |
$22,438.79
|
|
|
RESTORATION MOD HIP V40 21MM +
|
Facility
|
IP
|
$25,498.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,649.59 |
| Max. Negotiated Rate |
$24,478.68 |
| Rate for Payer: Aetna Commercial |
$19,633.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,888.92
|
| Rate for Payer: Cash Price |
$12,749.31
|
| Rate for Payer: Cigna Commercial |
$21,163.85
|
| Rate for Payer: First Health Commercial |
$24,223.69
|
| Rate for Payer: Humana Commercial |
$21,673.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,908.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,817.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,649.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,438.79
|
| Rate for Payer: Ohio Health Group HMO |
$19,123.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,398.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,183.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,594.05
|
| Rate for Payer: PHCS Commercial |
$24,478.68
|
| Rate for Payer: United Healthcare All Payer |
$22,438.79
|
|
|
RESTORATION MOD HIP V40 23MM +
|
Facility
|
OP
|
$25,498.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,649.59 |
| Max. Negotiated Rate |
$24,478.68 |
| Rate for Payer: Aetna Commercial |
$19,633.94
|
| Rate for Payer: Anthem Medicaid |
$8,768.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,888.92
|
| Rate for Payer: Cash Price |
$12,749.31
|
| Rate for Payer: Cigna Commercial |
$21,163.85
|
| Rate for Payer: First Health Commercial |
$24,223.69
|
| Rate for Payer: Humana Commercial |
$21,673.83
|
| Rate for Payer: Humana KY Medicaid |
$8,768.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,858.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,908.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,817.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,649.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,944.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,438.79
|
| Rate for Payer: Ohio Health Group HMO |
$19,123.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,398.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,183.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,594.05
|
| Rate for Payer: PHCS Commercial |
$24,478.68
|
| Rate for Payer: United Healthcare All Payer |
$22,438.79
|
|
|
RESTORATION MOD HIP V40 23MM +
|
Facility
|
IP
|
$25,498.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,649.59 |
| Max. Negotiated Rate |
$24,478.68 |
| Rate for Payer: Aetna Commercial |
$19,633.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,888.92
|
| Rate for Payer: Cash Price |
$12,749.31
|
| Rate for Payer: Cigna Commercial |
$21,163.85
|
| Rate for Payer: First Health Commercial |
$24,223.69
|
| Rate for Payer: Humana Commercial |
$21,673.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,908.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,817.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,649.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,438.79
|
| Rate for Payer: Ohio Health Group HMO |
$19,123.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,398.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,183.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,594.05
|
| Rate for Payer: PHCS Commercial |
$24,478.68
|
| Rate for Payer: United Healthcare All Payer |
$22,438.79
|
|
|
RESTORATION MOD PROX 31MM +0
|
Facility
|
OP
|
$18,924.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.42 |
| Max. Negotiated Rate |
$18,167.73 |
| Rate for Payer: Aetna Commercial |
$14,572.03
|
| Rate for Payer: Anthem Medicaid |
$6,508.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,761.28
|
| Rate for Payer: Cash Price |
$9,462.36
|
| Rate for Payer: Cigna Commercial |
$15,707.52
|
| Rate for Payer: First Health Commercial |
$17,978.48
|
| Rate for Payer: Humana Commercial |
$16,086.01
|
| Rate for Payer: Humana KY Medicaid |
$6,508.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,574.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,518.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,966.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,677.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,638.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,653.75
|
| Rate for Payer: Ohio Health Group HMO |
$14,193.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,139.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,058.06
|
| Rate for Payer: PHCS Commercial |
$18,167.73
|
| Rate for Payer: United Healthcare All Payer |
$16,653.75
|
|
|
RESTORATION MOD PROX 31MM +0
|
Facility
|
IP
|
$18,924.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.42 |
| Max. Negotiated Rate |
$18,167.73 |
| Rate for Payer: Aetna Commercial |
$14,572.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,761.28
|
| Rate for Payer: Cash Price |
$9,462.36
|
| Rate for Payer: Cigna Commercial |
$15,707.52
|
| Rate for Payer: First Health Commercial |
$17,978.48
|
| Rate for Payer: Humana Commercial |
$16,086.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,518.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,966.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,677.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,653.75
|
| Rate for Payer: Ohio Health Group HMO |
$14,193.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,139.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,058.06
|
| Rate for Payer: PHCS Commercial |
$18,167.73
|
| Rate for Payer: United Healthcare All Payer |
$16,653.75
|
|
|
RESTORATION MOD STD 29MM +0
|
Facility
|
IP
|
$18,924.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,677.42 |
| Max. Negotiated Rate |
$18,167.73 |
| Rate for Payer: Aetna Commercial |
$14,572.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,761.28
|
| Rate for Payer: Cash Price |
$9,462.36
|
| Rate for Payer: Cigna Commercial |
$15,707.52
|
| Rate for Payer: First Health Commercial |
$17,978.48
|
| Rate for Payer: Humana Commercial |
$16,086.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,518.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,966.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,677.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,653.75
|
| Rate for Payer: Ohio Health Group HMO |
$14,193.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,139.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,058.06
|
| Rate for Payer: PHCS Commercial |
$18,167.73
|
| Rate for Payer: United Healthcare All Payer |
$16,653.75
|
|
