|
RSP HUMERAL SOCKT INSRT 36MM+4
|
Facility
|
IP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUMERAL STEM SZ 6
|
Facility
|
OP
|
$15,655.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.62 |
| Max. Negotiated Rate |
$15,029.18 |
| Rate for Payer: Aetna Commercial |
$12,054.66
|
| Rate for Payer: Anthem Medicaid |
$5,383.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.21
|
| Rate for Payer: Cash Price |
$7,827.70
|
| Rate for Payer: Cigna Commercial |
$12,993.98
|
| Rate for Payer: First Health Commercial |
$14,872.63
|
| Rate for Payer: Humana Commercial |
$13,307.09
|
| Rate for Payer: Humana KY Medicaid |
$5,383.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,438.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,837.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,553.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,491.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,776.75
|
| Rate for Payer: Ohio Health Group HMO |
$11,741.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.23
|
| Rate for Payer: PHCS Commercial |
$15,029.18
|
| Rate for Payer: United Healthcare All Payer |
$13,776.75
|
|
|
RSP HUMERAL STEM SZ 6
|
Facility
|
IP
|
$15,655.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,696.62 |
| Max. Negotiated Rate |
$15,029.18 |
| Rate for Payer: Aetna Commercial |
$12,054.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,211.21
|
| Rate for Payer: Cash Price |
$7,827.70
|
| Rate for Payer: Cigna Commercial |
$12,993.98
|
| Rate for Payer: First Health Commercial |
$14,872.63
|
| Rate for Payer: Humana Commercial |
$13,307.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,837.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,553.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,696.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,776.75
|
| Rate for Payer: Ohio Health Group HMO |
$11,741.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,524.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,620.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,802.23
|
| Rate for Payer: PHCS Commercial |
$15,029.18
|
| Rate for Payer: United Healthcare All Payer |
$13,776.75
|
|
|
RSP HUMRL SOCKET INSRT 32MM +4
|
Facility
|
OP
|
$5,449.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.89 |
| Max. Negotiated Rate |
$5,231.64 |
| Rate for Payer: Aetna Commercial |
$4,196.21
|
| Rate for Payer: Anthem Medicaid |
$1,874.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,250.70
|
| Rate for Payer: Cash Price |
$2,724.81
|
| Rate for Payer: Cigna Commercial |
$4,523.18
|
| Rate for Payer: First Health Commercial |
$5,177.14
|
| Rate for Payer: Humana Commercial |
$4,632.18
|
| Rate for Payer: Humana KY Medicaid |
$1,874.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,893.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,468.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,021.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,795.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,087.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,359.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,741.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,760.24
|
| Rate for Payer: PHCS Commercial |
$5,231.64
|
| Rate for Payer: United Healthcare All Payer |
$4,795.67
|
|
|
RSP HUMRL SOCKET INSRT 32MM +4
|
Facility
|
IP
|
$5,449.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.89 |
| Max. Negotiated Rate |
$5,231.64 |
| Rate for Payer: Aetna Commercial |
$4,196.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,250.70
|
| Rate for Payer: Cash Price |
$2,724.81
|
| Rate for Payer: Cigna Commercial |
$4,523.18
|
| Rate for Payer: First Health Commercial |
$5,177.14
|
| Rate for Payer: Humana Commercial |
$4,632.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,468.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,021.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,795.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,087.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,359.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,741.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,760.24
|
| Rate for Payer: PHCS Commercial |
$5,231.64
|
| Rate for Payer: United Healthcare All Payer |
$4,795.67
|
|
|
RSP HUM SOCKET INSERT STD SZ 3
|
Facility
|
IP
|
$7,593.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.18 |
| Max. Negotiated Rate |
$7,290.17 |
| Rate for Payer: Aetna Commercial |
$5,847.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,923.27
|
| Rate for Payer: Cash Price |
$3,796.96
|
| Rate for Payer: Cigna Commercial |
$6,302.96
|
| Rate for Payer: First Health Commercial |
$7,214.23
|
| Rate for Payer: Humana Commercial |
$6,454.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,227.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,604.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,278.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,682.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,695.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,075.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,606.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,239.81
|
| Rate for Payer: PHCS Commercial |
$7,290.17
|
| Rate for Payer: United Healthcare All Payer |
$6,682.66
|
|
|
RSP HUM SOCKET INSERT STD SZ 3
|
Facility
|
OP
|
$7,593.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,278.18 |
| Max. Negotiated Rate |
$7,290.17 |
| Rate for Payer: Aetna Commercial |
$5,847.33
|
| Rate for Payer: Anthem Medicaid |
$2,611.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,923.27
|
| Rate for Payer: Cash Price |
$3,796.96
|
| Rate for Payer: Cigna Commercial |
$6,302.96
|
| Rate for Payer: First Health Commercial |
$7,214.23
|
| Rate for Payer: Humana Commercial |
$6,454.84
|
| Rate for Payer: Humana KY Medicaid |
$2,611.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,638.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,227.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,604.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,278.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,663.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,682.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,695.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,075.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,606.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,239.81
|
| Rate for Payer: PHCS Commercial |
$7,290.17
|
| Rate for Payer: United Healthcare All Payer |
$6,682.66
|
|
|
RSP HUM SOCKET INSRT SZ 32 +4
|
Facility
|
OP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem Medicaid |
$1,802.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Humana KY Medicaid |
$1,802.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ 32 +4
|
Facility
|
IP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ32MM +4
|
Facility
|
IP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ32MM +4
|
Facility
|
OP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem Medicaid |
$1,802.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Humana KY Medicaid |
$1,802.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ 32 STD
|
Facility
|
IP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ 32 STD
|
Facility
|
OP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem Medicaid |
$1,802.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Humana KY Medicaid |
$1,802.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ36M STD
|
Facility
|
IP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET INSRT SZ36M STD
|
Facility
|
OP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem Medicaid |
$1,802.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Humana KY Medicaid |
$1,802.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
RSP HUM SOCKET SHELL +8
|
Facility
|
IP
|
$9,110.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,733.03 |
| Max. Negotiated Rate |
$8,745.70 |
| Rate for Payer: Aetna Commercial |
$7,014.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,105.88
|
| Rate for Payer: Cash Price |
$4,555.05
|
| Rate for Payer: Cigna Commercial |
$7,561.38
|
| Rate for Payer: First Health Commercial |
$8,654.59
|
| Rate for Payer: Humana Commercial |
$7,743.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,470.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,723.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,733.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,016.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,832.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,288.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,925.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,285.97
|
| Rate for Payer: PHCS Commercial |
$8,745.70
|
| Rate for Payer: United Healthcare All Payer |
$8,016.89
|
|
|
RSP HUM SOCKET SHELL +8
|
Facility
|
OP
|
$9,110.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,733.03 |
| Max. Negotiated Rate |
$8,745.70 |
| Rate for Payer: Aetna Commercial |
$7,014.78
|
| Rate for Payer: Anthem Medicaid |
$3,132.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,105.88
|
| Rate for Payer: Cash Price |
$4,555.05
|
| Rate for Payer: Cigna Commercial |
$7,561.38
|
| Rate for Payer: First Health Commercial |
$8,654.59
|
| Rate for Payer: Humana Commercial |
$7,743.59
|
| Rate for Payer: Humana KY Medicaid |
$3,132.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,164.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,470.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,723.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,733.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,195.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,016.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,832.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,288.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,925.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,285.97
|
| Rate for Payer: PHCS Commercial |
$8,745.70
|
| Rate for Payer: United Healthcare All Payer |
$8,016.89
|
|
|
RSP MONOBLOCK REV HUM 6*175
|
Facility
|
OP
|
$31,446.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,434.10 |
| Max. Negotiated Rate |
$30,189.11 |
| Rate for Payer: Aetna Commercial |
$24,214.18
|
| Rate for Payer: Anthem Medicaid |
$10,814.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,528.65
|
| Rate for Payer: Cash Price |
$15,723.49
|
| Rate for Payer: Cigna Commercial |
$26,101.00
|
| Rate for Payer: First Health Commercial |
$29,874.64
|
| Rate for Payer: Humana Commercial |
$26,729.94
|
| Rate for Payer: Humana KY Medicaid |
$10,814.62
|
| Rate for Payer: Kentucky WC Medicaid |
$10,924.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,786.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,207.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,434.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,031.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,673.35
|
| Rate for Payer: Ohio Health Group HMO |
$23,585.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,157.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,358.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,698.42
|
| Rate for Payer: PHCS Commercial |
$30,189.11
|
| Rate for Payer: United Healthcare All Payer |
$27,673.35
|
|
|
RSP MONOBLOCK REV HUM 6*175
|
Facility
|
IP
|
$31,446.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,434.10 |
| Max. Negotiated Rate |
$30,189.11 |
| Rate for Payer: Aetna Commercial |
$24,214.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,528.65
|
| Rate for Payer: Cash Price |
$15,723.49
|
| Rate for Payer: Cigna Commercial |
$26,101.00
|
| Rate for Payer: First Health Commercial |
$29,874.64
|
| Rate for Payer: Humana Commercial |
$26,729.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,786.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,207.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,434.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,673.35
|
| Rate for Payer: Ohio Health Group HMO |
$23,585.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,157.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,358.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,698.42
|
| Rate for Payer: PHCS Commercial |
$30,189.11
|
| Rate for Payer: United Healthcare All Payer |
$27,673.35
|
|
|
RSP MONOBLOCK STEM SZ 6
|
Facility
|
OP
|
$26,753.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,026.12 |
| Max. Negotiated Rate |
$25,683.60 |
| Rate for Payer: Aetna Commercial |
$20,600.39
|
| Rate for Payer: Anthem Medicaid |
$9,200.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,867.92
|
| Rate for Payer: Cash Price |
$13,376.88
|
| Rate for Payer: Cigna Commercial |
$22,205.61
|
| Rate for Payer: First Health Commercial |
$25,416.06
|
| Rate for Payer: Humana Commercial |
$22,740.69
|
| Rate for Payer: Humana KY Medicaid |
$9,200.61
|
| Rate for Payer: Kentucky WC Medicaid |
$9,294.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,744.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,026.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,385.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,543.30
|
| Rate for Payer: Ohio Health Group HMO |
$20,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,275.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,460.09
|
| Rate for Payer: PHCS Commercial |
$25,683.60
|
| Rate for Payer: United Healthcare All Payer |
$23,543.30
|
|
|
RSP MONOBLOCK STEM SZ 6
|
Facility
|
IP
|
$26,753.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,026.12 |
| Max. Negotiated Rate |
$25,683.60 |
| Rate for Payer: Aetna Commercial |
$20,600.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,867.92
|
| Rate for Payer: Cash Price |
$13,376.88
|
| Rate for Payer: Cigna Commercial |
$22,205.61
|
| Rate for Payer: First Health Commercial |
$25,416.06
|
| Rate for Payer: Humana Commercial |
$22,740.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,744.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,026.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,543.30
|
| Rate for Payer: Ohio Health Group HMO |
$20,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,275.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,460.09
|
| Rate for Payer: PHCS Commercial |
$25,683.60
|
| Rate for Payer: United Healthcare All Payer |
$23,543.30
|
|
|
RSP MONOBLOCK STEM SZ 7
|
Facility
|
OP
|
$26,753.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,026.12 |
| Max. Negotiated Rate |
$25,683.60 |
| Rate for Payer: Aetna Commercial |
$20,600.39
|
| Rate for Payer: Anthem Medicaid |
$9,200.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,867.92
|
| Rate for Payer: Cash Price |
$13,376.88
|
| Rate for Payer: Cigna Commercial |
$22,205.61
|
| Rate for Payer: First Health Commercial |
$25,416.06
|
| Rate for Payer: Humana Commercial |
$22,740.69
|
| Rate for Payer: Humana KY Medicaid |
$9,200.61
|
| Rate for Payer: Kentucky WC Medicaid |
$9,294.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,744.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,026.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,385.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,543.30
|
| Rate for Payer: Ohio Health Group HMO |
$20,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,275.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,460.09
|
| Rate for Payer: PHCS Commercial |
$25,683.60
|
| Rate for Payer: United Healthcare All Payer |
$23,543.30
|
|
|
RSP MONOBLOCK STEM SZ 7
|
Facility
|
IP
|
$26,753.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,026.12 |
| Max. Negotiated Rate |
$25,683.60 |
| Rate for Payer: Aetna Commercial |
$20,600.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,867.92
|
| Rate for Payer: Cash Price |
$13,376.88
|
| Rate for Payer: Cigna Commercial |
$22,205.61
|
| Rate for Payer: First Health Commercial |
$25,416.06
|
| Rate for Payer: Humana Commercial |
$22,740.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,744.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,026.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,543.30
|
| Rate for Payer: Ohio Health Group HMO |
$20,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,275.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,460.09
|
| Rate for Payer: PHCS Commercial |
$25,683.60
|
| Rate for Payer: United Healthcare All Payer |
$23,543.30
|
|
|
RSP MONOBLOCK STEM SZ 8
|
Facility
|
IP
|
$26,753.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,026.12 |
| Max. Negotiated Rate |
$25,683.60 |
| Rate for Payer: Aetna Commercial |
$20,600.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,867.92
|
| Rate for Payer: Cash Price |
$13,376.88
|
| Rate for Payer: Cigna Commercial |
$22,205.61
|
| Rate for Payer: First Health Commercial |
$25,416.06
|
| Rate for Payer: Humana Commercial |
$22,740.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,744.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,026.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,543.30
|
| Rate for Payer: Ohio Health Group HMO |
$20,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,275.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,460.09
|
| Rate for Payer: PHCS Commercial |
$25,683.60
|
| Rate for Payer: United Healthcare All Payer |
$23,543.30
|
|
|
RSP MONOBLOCK STEM SZ 8
|
Facility
|
OP
|
$26,753.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,026.12 |
| Max. Negotiated Rate |
$25,683.60 |
| Rate for Payer: Aetna Commercial |
$20,600.39
|
| Rate for Payer: Anthem Medicaid |
$9,200.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,867.92
|
| Rate for Payer: Cash Price |
$13,376.88
|
| Rate for Payer: Cigna Commercial |
$22,205.61
|
| Rate for Payer: First Health Commercial |
$25,416.06
|
| Rate for Payer: Humana Commercial |
$22,740.69
|
| Rate for Payer: Humana KY Medicaid |
$9,200.61
|
| Rate for Payer: Kentucky WC Medicaid |
$9,294.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,744.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,026.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,385.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,543.30
|
| Rate for Payer: Ohio Health Group HMO |
$20,065.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,275.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,460.09
|
| Rate for Payer: PHCS Commercial |
$25,683.60
|
| Rate for Payer: United Healthcare All Payer |
$23,543.30
|
|
