|
ARTICULEZE 12/14 40MM SPEC+8.5
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 44MM SPEC+12
|
Facility
|
OP
|
$8,299.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,489.94 |
| Max. Negotiated Rate |
$7,967.81 |
| Rate for Payer: Aetna Commercial |
$6,390.85
|
| Rate for Payer: Anthem Medicaid |
$2,854.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,473.84
|
| Rate for Payer: Cash Price |
$4,149.90
|
| Rate for Payer: Cigna Commercial |
$6,888.83
|
| Rate for Payer: First Health Commercial |
$7,884.81
|
| Rate for Payer: Humana Commercial |
$7,054.83
|
| Rate for Payer: Humana KY Medicaid |
$2,854.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,883.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,805.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,125.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,489.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,911.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,303.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,224.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,639.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,220.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,726.86
|
| Rate for Payer: PHCS Commercial |
$7,967.81
|
| Rate for Payer: United Healthcare All Payer |
$7,303.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+12
|
Facility
|
IP
|
$8,299.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,489.94 |
| Max. Negotiated Rate |
$7,967.81 |
| Rate for Payer: Aetna Commercial |
$6,390.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,473.84
|
| Rate for Payer: Cash Price |
$4,149.90
|
| Rate for Payer: Cigna Commercial |
$6,888.83
|
| Rate for Payer: First Health Commercial |
$7,884.81
|
| Rate for Payer: Humana Commercial |
$7,054.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,805.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,125.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,489.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,303.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,224.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,639.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,220.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,726.86
|
| Rate for Payer: PHCS Commercial |
$7,967.81
|
| Rate for Payer: United Healthcare All Payer |
$7,303.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+1.5
|
Facility
|
OP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem Medicaid |
$3,160.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Humana KY Medicaid |
$3,160.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,193.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+1.5
|
Facility
|
IP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZE 12/14 44MM SPEC-2
|
Facility
|
OP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem Medicaid |
$3,160.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Humana KY Medicaid |
$3,160.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,193.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZE 12/14 44MM SPEC-2
|
Facility
|
IP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+5
|
Facility
|
IP
|
$8,299.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,489.94 |
| Max. Negotiated Rate |
$7,967.81 |
| Rate for Payer: Aetna Commercial |
$6,390.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,473.84
|
| Rate for Payer: Cash Price |
$4,149.90
|
| Rate for Payer: Cigna Commercial |
$6,888.83
|
| Rate for Payer: First Health Commercial |
$7,884.81
|
| Rate for Payer: Humana Commercial |
$7,054.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,805.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,125.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,489.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,303.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,224.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,639.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,220.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,726.86
|
| Rate for Payer: PHCS Commercial |
$7,967.81
|
| Rate for Payer: United Healthcare All Payer |
$7,303.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+5
|
Facility
|
OP
|
$8,299.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,489.94 |
| Max. Negotiated Rate |
$7,967.81 |
| Rate for Payer: Aetna Commercial |
$6,390.85
|
| Rate for Payer: Anthem Medicaid |
$2,854.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,473.84
|
| Rate for Payer: Cash Price |
$4,149.90
|
| Rate for Payer: Cigna Commercial |
$6,888.83
|
| Rate for Payer: First Health Commercial |
$7,884.81
|
| Rate for Payer: Humana Commercial |
$7,054.83
|
| Rate for Payer: Humana KY Medicaid |
$2,854.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,883.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,805.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,125.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,489.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,911.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,303.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,224.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,639.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,220.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,726.86
|
| Rate for Payer: PHCS Commercial |
$7,967.81
|
| Rate for Payer: United Healthcare All Payer |
$7,303.82
|
|
|
ARTICULEZE 12/14 44MM SPEC+8.5
|
Facility
|
OP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem Medicaid |
$3,160.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Humana KY Medicaid |
$3,160.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,193.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZE 12/14 44MM SPEC+8.5
|
Facility
|
IP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICUL/EZE FEM HEAD 32MM 13
|
Facility
|
OP
|
$4,607.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.33 |
| Max. Negotiated Rate |
$4,423.44 |
| Rate for Payer: Aetna Commercial |
$3,547.97
|
| Rate for Payer: Anthem Medicaid |
$1,584.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.05
|
| Rate for Payer: Cash Price |
$2,303.88
|
| Rate for Payer: Cigna Commercial |
$3,824.43
|
| Rate for Payer: First Health Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial |
$3,916.59
|
| Rate for Payer: Humana KY Medicaid |
$1,584.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,616.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,054.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,455.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,008.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,179.35
|
| Rate for Payer: PHCS Commercial |
$4,423.44
|
| Rate for Payer: United Healthcare All Payer |
$4,054.82
|
|
|
ARTICUL/EZE FEM HEAD 32MM 13
|
Facility
|
IP
|
$4,607.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.33 |
| Max. Negotiated Rate |
$4,423.44 |
| Rate for Payer: Aetna Commercial |
$3,547.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.05
|
| Rate for Payer: Cash Price |
$2,303.88
|
| Rate for Payer: Cigna Commercial |
$3,824.43
|
| Rate for Payer: First Health Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial |
$3,916.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,054.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,455.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,008.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,179.35
|
| Rate for Payer: PHCS Commercial |
$4,423.44
|
| Rate for Payer: United Healthcare All Payer |
$4,054.82
|
|
|
ARTICUL/EZE HIP BALL 32MM 1
|
Facility
|
OP
|
$4,607.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.33 |
| Max. Negotiated Rate |
$4,423.44 |
| Rate for Payer: Aetna Commercial |
$3,547.97
|
| Rate for Payer: Anthem Medicaid |
$1,584.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.05
|
| Rate for Payer: Cash Price |
$2,303.88
|
| Rate for Payer: Cigna Commercial |
$3,824.43
|
| Rate for Payer: First Health Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial |
$3,916.59
|
| Rate for Payer: Humana KY Medicaid |
$1,584.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,616.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,054.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,455.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,008.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,179.35
|
| Rate for Payer: PHCS Commercial |
$4,423.44
|
| Rate for Payer: United Healthcare All Payer |
$4,054.82
|
|
|
ARTICUL/EZE HIP BALL 32MM 1
|
Facility
|
IP
|
$4,607.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.33 |
| Max. Negotiated Rate |
$4,423.44 |
| Rate for Payer: Aetna Commercial |
$3,547.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.05
|
| Rate for Payer: Cash Price |
$2,303.88
|
| Rate for Payer: Cigna Commercial |
$3,824.43
|
| Rate for Payer: First Health Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial |
$3,916.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,054.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,455.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,008.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,179.35
|
| Rate for Payer: PHCS Commercial |
$4,423.44
|
| Rate for Payer: United Healthcare All Payer |
$4,054.82
|
|
|
ARTICUL/EZE HIP BALL 32MM 17
|
Facility
|
OP
|
$4,530.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.29 |
| Max. Negotiated Rate |
$4,349.71 |
| Rate for Payer: Aetna Commercial |
$3,488.83
|
| Rate for Payer: Anthem Medicaid |
$1,558.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.14
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cigna Commercial |
$3,760.69
|
| Rate for Payer: First Health Commercial |
$4,304.40
|
| Rate for Payer: Humana Commercial |
$3,851.31
|
| Rate for Payer: Humana KY Medicaid |
$1,558.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,624.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,941.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.36
|
| Rate for Payer: PHCS Commercial |
$4,349.71
|
| Rate for Payer: United Healthcare All Payer |
$3,987.24
|
|
|
ARTICUL/EZE HIP BALL 32MM 17
|
Facility
|
IP
|
$4,530.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.29 |
| Max. Negotiated Rate |
$4,349.71 |
| Rate for Payer: Aetna Commercial |
$3,488.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.14
|
| Rate for Payer: Cash Price |
$2,265.48
|
| Rate for Payer: Cigna Commercial |
$3,760.69
|
| Rate for Payer: First Health Commercial |
$4,304.40
|
| Rate for Payer: Humana Commercial |
$3,851.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,624.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,941.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.36
|
| Rate for Payer: PHCS Commercial |
$4,349.71
|
| Rate for Payer: United Healthcare All Payer |
$3,987.24
|
|
|
ARTICUL/EZE HIP BALL 32MM 5
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICUL/EZE HIP BALL 32MM 5
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICUL/EZE HIP BALL 32MM 9
|
Facility
|
IP
|
$4,607.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.33 |
| Max. Negotiated Rate |
$4,423.44 |
| Rate for Payer: Aetna Commercial |
$3,547.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.05
|
| Rate for Payer: Cash Price |
$2,303.88
|
| Rate for Payer: Cigna Commercial |
$3,824.43
|
| Rate for Payer: First Health Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial |
$3,916.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,054.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,455.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,008.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,179.35
|
| Rate for Payer: PHCS Commercial |
$4,423.44
|
| Rate for Payer: United Healthcare All Payer |
$4,054.82
|
|
|
ARTICUL/EZE HIP BALL 32MM 9
|
Facility
|
OP
|
$4,607.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,382.33 |
| Max. Negotiated Rate |
$4,423.44 |
| Rate for Payer: Aetna Commercial |
$3,547.97
|
| Rate for Payer: Anthem Medicaid |
$1,584.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,594.05
|
| Rate for Payer: Cash Price |
$2,303.88
|
| Rate for Payer: Cigna Commercial |
$3,824.43
|
| Rate for Payer: First Health Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial |
$3,916.59
|
| Rate for Payer: Humana KY Medicaid |
$1,584.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,778.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,400.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,382.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,616.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,054.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,455.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,686.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,008.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,179.35
|
| Rate for Payer: PHCS Commercial |
$4,423.44
|
| Rate for Payer: United Healthcare All Payer |
$4,054.82
|
|
|
ARTICUL/EZE METAL FEM HD 36MM1
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICUL/EZE METAL FEM HD 36MM1
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE METAL HIP BALL 36M
|
Facility
|
IP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
ARTICULEZE METAL HIP BALL 36M
|
Facility
|
OP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem Medicaid |
$2,334.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Humana KY Medicaid |
$2,334.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
