|
ACETABULAR CUP 46MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 46MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 48MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 48MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 50MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 50MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 52MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 52MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 54MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 54MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 56MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 56MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 58MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 58MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 60MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 60MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 62MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 62MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 64MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 64MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 66MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ACETABULAR CUP 66MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ACETABULAR LINER 32ID54-56ODW
|
Facility
|
IP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
ACETABULAR LINER 32ID54-56ODW
|
Facility
|
OP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem Medicaid |
$3,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Humana KY Medicaid |
$3,055.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,086.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
ACETABULAR LINER 32ID58-60ODW
|
Facility
|
OP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem Medicaid |
$3,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Humana KY Medicaid |
$3,055.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,086.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
