|
BF OFFSET HUM HEAD 27*56
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 27*56
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 30*46
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 30*46
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 30*52
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 30*52
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 30*56
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 30*56
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 33*52
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 33*52
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 33*56
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 33*56
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF PEGGED 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 PEGGED 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 PEGGED 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 PEGGED 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 PEGGED 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 PEGGED 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
|
|
|
BHR-2MM ACE CUO HAP SZ 48/54
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR-2MM ACE CUO HAP SZ 48/54
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP AZ 48/56
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP AZ 48/56
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 40/46
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 40/46
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 40/48
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
