|
RRAD 5F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
RR PHYSICAL
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
RR PHYSICAL
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
RR PHYSICAL
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.68
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
RR PHYSICAL(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99450
|
| Hospital Charge Code |
510P0114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.68
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
|
|
RSP GLENOD HD W/RET SCRW-4M 32
|
Facility
|
OP
|
$7,004.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$6,724.61 |
| Rate for Payer: Aetna Commercial |
$5,393.70
|
| Rate for Payer: Anthem Medicaid |
$2,408.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.74
|
| Rate for Payer: Cash Price |
$3,502.40
|
| Rate for Payer: Cigna Commercial |
$5,813.98
|
| Rate for Payer: First Health Commercial |
$6,654.56
|
| Rate for Payer: Humana Commercial |
$5,954.08
|
| Rate for Payer: Humana KY Medicaid |
$2,408.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,743.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.49
|
| Rate for Payer: PHCS Commercial |
$6,724.61
|
| Rate for Payer: United Healthcare All Payer |
$6,164.22
|
|
|
RSP GLENOD HD W/RET SCRW-4M 32
|
Facility
|
IP
|
$7,004.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$6,724.61 |
| Rate for Payer: Aetna Commercial |
$5,393.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.74
|
| Rate for Payer: Cash Price |
$3,502.40
|
| Rate for Payer: Cigna Commercial |
$5,813.98
|
| Rate for Payer: First Health Commercial |
$6,654.56
|
| Rate for Payer: Humana Commercial |
$5,954.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,743.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.49
|
| Rate for Payer: PHCS Commercial |
$6,724.61
|
| Rate for Payer: United Healthcare All Payer |
$6,164.22
|
|
|
RSP GLENOID BASEPLATE 30MM
|
Facility
|
IP
|
$8,121.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.82 |
| Max. Negotiated Rate |
$7,796.83 |
| Rate for Payer: Aetna Commercial |
$6,253.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,334.93
|
| Rate for Payer: Cash Price |
$4,060.85
|
| Rate for Payer: Cigna Commercial |
$6,741.01
|
| Rate for Payer: First Health Commercial |
$7,715.62
|
| Rate for Payer: Humana Commercial |
$6,903.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,659.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,993.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,436.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,147.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,091.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,517.73
|
| Rate for Payer: PHCS Commercial |
$7,796.83
|
| Rate for Payer: United Healthcare All Payer |
$7,147.10
|
|
|
RSP GLENOID BASEPLATE 30MM
|
Facility
|
OP
|
$8,121.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.82 |
| Max. Negotiated Rate |
$7,796.83 |
| Rate for Payer: Aetna Commercial |
$6,253.71
|
| Rate for Payer: Anthem Medicaid |
$2,793.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,334.93
|
| Rate for Payer: Cash Price |
$4,060.85
|
| Rate for Payer: Cigna Commercial |
$6,741.01
|
| Rate for Payer: First Health Commercial |
$7,715.62
|
| Rate for Payer: Humana Commercial |
$6,903.44
|
| Rate for Payer: Humana KY Medicaid |
$2,793.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,821.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,659.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,993.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,436.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,849.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,147.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,091.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,517.73
|
| Rate for Payer: PHCS Commercial |
$7,796.83
|
| Rate for Payer: United Healthcare All Payer |
$7,147.10
|
|
|
RSP GLENOID HD W/RET SCRW NEU
|
Facility
|
IP
|
$8,060.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.80 |
| Max. Negotiated Rate |
$7,737.62 |
| Rate for Payer: Aetna Commercial |
$6,206.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,286.82
|
| Rate for Payer: Cash Price |
$4,030.01
|
| Rate for Payer: Cigna Commercial |
$6,689.82
|
| Rate for Payer: First Health Commercial |
$7,657.02
|
| Rate for Payer: Humana Commercial |
$6,851.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,609.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,948.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,418.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,092.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,045.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,498.61
|
| Rate for Payer: PHCS Commercial |
$7,737.62
|
| Rate for Payer: United Healthcare All Payer |
$7,092.82
|
|
|
RSP GLENOID HD W/RET SCRW NEU
|
Facility
|
OP
|
$8,060.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.80 |
| Max. Negotiated Rate |
$7,737.62 |
| Rate for Payer: Aetna Commercial |
$6,206.22
|
| Rate for Payer: Anthem Medicaid |
$2,771.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,286.82
|
| Rate for Payer: Cash Price |
$4,030.01
|
| Rate for Payer: Cigna Commercial |
$6,689.82
|
| Rate for Payer: First Health Commercial |
$7,657.02
|
| Rate for Payer: Humana Commercial |
$6,851.02
|
| Rate for Payer: Humana KY Medicaid |
$2,771.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,800.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,609.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,948.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,418.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,827.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,092.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,045.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,498.61
|
| Rate for Payer: PHCS Commercial |
$7,737.62
|
| Rate for Payer: United Healthcare All Payer |
$7,092.82
|
|
|
RSP HUMERAL SOCKT INSRT 36MM+4
|
Facility
|
OP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem Medicaid |
$1,796.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Humana KY Medicaid |
$1,796.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUMERAL SOCKT INSRT 36MM+4
|
Facility
|
IP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUMERAL STEM SZ 6
|
Facility
|
OP
|
$15,151.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.66 |
| Max. Negotiated Rate |
$14,545.15 |
| Rate for Payer: Aetna Commercial |
$11,666.42
|
| Rate for Payer: Anthem Medicaid |
$5,210.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,817.94
|
| Rate for Payer: Cash Price |
$7,575.60
|
| Rate for Payer: Cigna Commercial |
$12,575.50
|
| Rate for Payer: First Health Commercial |
$14,393.64
|
| Rate for Payer: Humana Commercial |
$12,878.52
|
| Rate for Payer: Humana KY Medicaid |
$5,210.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,263.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,423.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,181.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,315.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.06
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,696.87
|
| Rate for Payer: PHCS Commercial |
$14,545.15
|
| Rate for Payer: United Healthcare All Payer |
$13,333.06
|
|
|
RSP HUMERAL STEM SZ 6
|
Facility
|
IP
|
$15,151.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.66 |
| Max. Negotiated Rate |
$14,545.15 |
| Rate for Payer: Aetna Commercial |
$11,666.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,817.94
|
| Rate for Payer: Cash Price |
$7,575.60
|
| Rate for Payer: Cigna Commercial |
$12,575.50
|
| Rate for Payer: First Health Commercial |
$14,393.64
|
| Rate for Payer: Humana Commercial |
$12,878.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,423.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,181.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,545.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,333.06
|
| Rate for Payer: Ohio Health Group HMO |
$11,363.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,030.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,969.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,696.87
|
| Rate for Payer: PHCS Commercial |
$14,545.15
|
| Rate for Payer: United Healthcare All Payer |
$13,333.06
|
|
|
RSP HUMRL SOCKET INSRT 32MM +4
|
Facility
|
OP
|
$5,419.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.55 |
| Max. Negotiated Rate |
$5,202.86 |
| Rate for Payer: Aetna Commercial |
$4,173.13
|
| Rate for Payer: Anthem Medicaid |
$1,863.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,227.33
|
| Rate for Payer: Cash Price |
$2,709.82
|
| Rate for Payer: Cigna Commercial |
$4,498.31
|
| Rate for Payer: First Health Commercial |
$5,148.67
|
| Rate for Payer: Humana Commercial |
$4,606.70
|
| Rate for Payer: Humana KY Medicaid |
$1,863.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,882.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,444.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,999.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,625.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,901.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,769.29
|
| Rate for Payer: Ohio Health Group HMO |
$4,064.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,083.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,680.09
|
| Rate for Payer: PHCS Commercial |
$5,202.86
|
| Rate for Payer: United Healthcare All Payer |
$4,769.29
|
|
|
RSP HUMRL SOCKET INSRT 32MM +4
|
Facility
|
IP
|
$5,419.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$704.55 |
| Max. Negotiated Rate |
$5,202.86 |
| Rate for Payer: Aetna Commercial |
$4,173.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,227.33
|
| Rate for Payer: Cash Price |
$2,709.82
|
| Rate for Payer: Cigna Commercial |
$4,498.31
|
| Rate for Payer: First Health Commercial |
$5,148.67
|
| Rate for Payer: Humana Commercial |
$4,606.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,444.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,999.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,625.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,769.29
|
| Rate for Payer: Ohio Health Group HMO |
$4,064.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,083.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,680.09
|
| Rate for Payer: PHCS Commercial |
$5,202.86
|
| Rate for Payer: United Healthcare All Payer |
$4,769.29
|
|
|
RSP HUM SOCKET INSERT STD SZ 3
|
Facility
|
IP
|
$7,393.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.21 |
| Max. Negotiated Rate |
$7,098.17 |
| Rate for Payer: Aetna Commercial |
$5,693.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,767.27
|
| Rate for Payer: Cash Price |
$3,696.96
|
| Rate for Payer: Cigna Commercial |
$6,136.96
|
| Rate for Payer: First Health Commercial |
$7,024.23
|
| Rate for Payer: Humana Commercial |
$6,284.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,063.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,456.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,218.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,506.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,545.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,292.12
|
| Rate for Payer: PHCS Commercial |
$7,098.17
|
| Rate for Payer: United Healthcare All Payer |
$6,506.66
|
|
|
RSP HUM SOCKET INSERT STD SZ 3
|
Facility
|
OP
|
$7,393.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$961.21 |
| Max. Negotiated Rate |
$7,098.17 |
| Rate for Payer: Aetna Commercial |
$5,693.33
|
| Rate for Payer: Anthem Medicaid |
$2,542.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,767.27
|
| Rate for Payer: Cash Price |
$3,696.96
|
| Rate for Payer: Cigna Commercial |
$6,136.96
|
| Rate for Payer: First Health Commercial |
$7,024.23
|
| Rate for Payer: Humana Commercial |
$6,284.84
|
| Rate for Payer: Humana KY Medicaid |
$2,542.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,568.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,063.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,456.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,218.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,593.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,506.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,545.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,292.12
|
| Rate for Payer: PHCS Commercial |
$7,098.17
|
| Rate for Payer: United Healthcare All Payer |
$6,506.66
|
|
|
RSP HUM SOCKET INSRT SZ 32 +4
|
Facility
|
IP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET INSRT SZ 32 +4
|
Facility
|
OP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem Medicaid |
$1,796.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Humana KY Medicaid |
$1,796.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET INSRT SZ32MM +4
|
Facility
|
IP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET INSRT SZ32MM +4
|
Facility
|
OP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem Medicaid |
$1,796.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Humana KY Medicaid |
$1,796.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET INSRT SZ 32 STD
|
Facility
|
OP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem Medicaid |
$1,796.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Humana KY Medicaid |
$1,796.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
RSP HUM SOCKET INSRT SZ 32 STD
|
Facility
|
IP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
