|
AS HUMERAL HEAD FX RT 44
|
Facility
|
OP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem Medicaid |
$4,039.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Humana KY Medicaid |
$4,039.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,080.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,120.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX RT 44
|
Facility
|
IP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX RT 48
|
Facility
|
OP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem Medicaid |
$4,039.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Humana KY Medicaid |
$4,039.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,080.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,120.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX RT 48
|
Facility
|
IP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL STEM 7-170
|
Facility
|
OP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem Medicaid |
$8,239.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Humana KY Medicaid |
$8,239.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM 7-170
|
Facility
|
IP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM FX 11-200
|
Facility
|
OP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem Medicaid |
$8,239.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Humana KY Medicaid |
$8,239.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM FX 11-200
|
Facility
|
IP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM FX13200
|
Facility
|
IP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM FX13200
|
Facility
|
OP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem Medicaid |
$8,239.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Humana KY Medicaid |
$8,239.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM FX 9-200
|
Facility
|
IP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS HUMERAL STEM FX 9-200
|
Facility
|
OP
|
$23,960.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,188.00 |
| Max. Negotiated Rate |
$23,001.60 |
| Rate for Payer: Aetna Commercial |
$18,449.20
|
| Rate for Payer: Anthem Medicaid |
$8,239.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,688.80
|
| Rate for Payer: Cash Price |
$11,980.00
|
| Rate for Payer: Cigna Commercial |
$19,886.80
|
| Rate for Payer: First Health Commercial |
$22,762.00
|
| Rate for Payer: Humana Commercial |
$20,366.00
|
| Rate for Payer: Humana KY Medicaid |
$8,239.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,323.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,647.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,682.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,188.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,084.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,845.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,532.40
|
| Rate for Payer: PHCS Commercial |
$23,001.60
|
| Rate for Payer: United Healthcare All Payer |
$21,084.80
|
|
|
AS INVERSE GLENDOID HEAD 36MM
|
Facility
|
OP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem Medicaid |
$3,491.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Humana KY Medicaid |
$3,491.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,527.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,562.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
AS INVERSE GLENDOID HEAD 36MM
|
Facility
|
IP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
AS INVERSE GLND FIX BASE PLATE
|
Facility
|
OP
|
$12,040.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.03 |
| Max. Negotiated Rate |
$11,558.49 |
| Rate for Payer: Aetna Commercial |
$9,270.87
|
| Rate for Payer: Anthem Medicaid |
$4,140.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,391.27
|
| Rate for Payer: Cash Price |
$6,020.04
|
| Rate for Payer: Cigna Commercial |
$9,993.27
|
| Rate for Payer: First Health Commercial |
$11,438.09
|
| Rate for Payer: Humana Commercial |
$10,234.08
|
| Rate for Payer: Humana KY Medicaid |
$4,140.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,182.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,872.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,885.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,223.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,030.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,632.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,474.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,307.66
|
| Rate for Payer: PHCS Commercial |
$11,558.49
|
| Rate for Payer: United Healthcare All Payer |
$10,595.28
|
|
|
AS INVERSE GLND FIX BASE PLATE
|
Facility
|
IP
|
$12,040.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.03 |
| Max. Negotiated Rate |
$11,558.49 |
| Rate for Payer: Aetna Commercial |
$9,270.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,391.27
|
| Rate for Payer: Cash Price |
$6,020.04
|
| Rate for Payer: Cigna Commercial |
$9,993.27
|
| Rate for Payer: First Health Commercial |
$11,438.09
|
| Rate for Payer: Humana Commercial |
$10,234.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,872.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,885.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,030.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,632.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,474.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,307.66
|
| Rate for Payer: PHCS Commercial |
$11,558.49
|
| Rate for Payer: United Healthcare All Payer |
$10,595.28
|
|
|
AS INVERSE GLND HD 40MM
|
Facility
|
IP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
AS INVERSE GLND HD 40MM
|
Facility
|
OP
|
$10,154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,046.20 |
| Max. Negotiated Rate |
$9,747.84 |
| Rate for Payer: Aetna Commercial |
$7,818.58
|
| Rate for Payer: Anthem Medicaid |
$3,491.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,920.12
|
| Rate for Payer: Cash Price |
$5,077.00
|
| Rate for Payer: Cigna Commercial |
$8,427.82
|
| Rate for Payer: First Health Commercial |
$9,646.30
|
| Rate for Payer: Humana Commercial |
$8,630.90
|
| Rate for Payer: Humana KY Medicaid |
$3,491.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,527.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,326.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,493.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,046.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,562.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,935.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,615.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,833.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,006.26
|
| Rate for Payer: PHCS Commercial |
$9,747.84
|
| Rate for Payer: United Healthcare All Payer |
$8,935.52
|
|
|
AS INVERSE HUM CUP 0 DEG +6MM
|
Facility
|
IP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INVERSE HUM CUP 0 DEG +6MM
|
Facility
|
OP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem Medicaid |
$3,086.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Humana KY Medicaid |
$3,086.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,117.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,148.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INVERSE HUM CUP 0 DEG RETRO
|
Facility
|
IP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INVERSE HUM CUP 0 DEG RETRO
|
Facility
|
OP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem Medicaid |
$3,086.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Humana KY Medicaid |
$3,086.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,117.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,148.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INVERSE HUM CUP+10DEG RETRO
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVERSE HUM CUP+10DEG RETRO
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVERSE HUM CUP-10DEG RETRO
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
