|
ACE SCREW CANC F/THRD 4.0*60MM
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.50 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
ACE SCREW CANC LAG 4.0*14MM
|
Facility
|
IP
|
$1,130.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.27 |
| Max. Negotiated Rate |
$1,085.66 |
| Rate for Payer: Aetna Commercial |
$870.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.10
|
| Rate for Payer: Cash Price |
$565.45
|
| Rate for Payer: Cigna Commercial |
$938.65
|
| Rate for Payer: First Health Commercial |
$1,074.36
|
| Rate for Payer: Humana Commercial |
$961.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.19
|
| Rate for Payer: Ohio Health Group HMO |
$848.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.32
|
| Rate for Payer: PHCS Commercial |
$1,085.66
|
| Rate for Payer: United Healthcare All Payer |
$995.19
|
|
|
ACE SCREW CANC LAG 4.0*14MM
|
Facility
|
OP
|
$1,130.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.27 |
| Max. Negotiated Rate |
$1,085.66 |
| Rate for Payer: Aetna Commercial |
$870.79
|
| Rate for Payer: Anthem Medicaid |
$388.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.10
|
| Rate for Payer: Cash Price |
$565.45
|
| Rate for Payer: Cigna Commercial |
$938.65
|
| Rate for Payer: First Health Commercial |
$1,074.36
|
| Rate for Payer: Humana Commercial |
$961.26
|
| Rate for Payer: Humana KY Medicaid |
$388.92
|
| Rate for Payer: Kentucky WC Medicaid |
$392.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.19
|
| Rate for Payer: Ohio Health Group HMO |
$848.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.32
|
| Rate for Payer: PHCS Commercial |
$1,085.66
|
| Rate for Payer: United Healthcare All Payer |
$995.19
|
|
|
ACE SCREW CANC LAG 4.0*16MM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
ACE SCREW CANC LAG 4.0*16MM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
ACE SCREW CANC LAG 4.0*18MM
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
ACE SCREW CANC LAG 4.0*18MM
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
ACETABULAR CUP 44MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 44MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 46MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 46MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 48MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 48MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 50MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 50MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 52MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 52MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 54MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 54MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 56MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 56MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 58MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 58MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 60MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 60MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
