|
TM KEEL GLEN 52MM W/56MM SRFC
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 52MM W/56MM SRFC
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLENOD 40MM W/46M SURF
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 40MM W/46M SURF
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 46MM W/40M SURF
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 46MM W/40M SURF
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 46MM W/52M SURF
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 46MM W/52M SURF
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 52MM W/46MM SRF
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 52MM W/46MM SRF
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 52MM W/56MM SRF
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOD 52MM W/56MM SRF
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOID 40MM
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOID 40MM
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOID 46MM
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOID 46MM
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOID 52MM
|
Facility
|
IP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM KEEL GLENOID 52MM
|
Facility
|
OP
|
$9,095.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.42 |
| Max. Negotiated Rate |
$8,731.70 |
| Rate for Payer: Aetna Commercial |
$7,003.55
|
| Rate for Payer: Anthem Medicaid |
$3,127.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.51
|
| Rate for Payer: Cash Price |
$4,547.76
|
| Rate for Payer: Cigna Commercial |
$7,549.28
|
| Rate for Payer: First Health Commercial |
$8,640.74
|
| Rate for Payer: Humana Commercial |
$7,731.19
|
| Rate for Payer: Humana KY Medicaid |
$3,127.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,819.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,819.61
|
| Rate for Payer: PHCS Commercial |
$8,731.70
|
| Rate for Payer: United Healthcare All Payer |
$8,004.06
|
|
|
TM REV 36MM 65 DEG POLY LNR +0
|
Facility
|
OP
|
$8,185.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.17 |
| Max. Negotiated Rate |
$7,858.50 |
| Rate for Payer: Aetna Commercial |
$6,303.17
|
| Rate for Payer: Anthem Medicaid |
$2,815.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,385.03
|
| Rate for Payer: Cash Price |
$4,092.97
|
| Rate for Payer: Cigna Commercial |
$6,794.33
|
| Rate for Payer: First Health Commercial |
$7,776.64
|
| Rate for Payer: Humana Commercial |
$6,958.05
|
| Rate for Payer: Humana KY Medicaid |
$2,815.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,041.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,871.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.64
|
| Rate for Payer: PHCS Commercial |
$7,858.50
|
| Rate for Payer: United Healthcare All Payer |
$7,203.63
|
|
|
TM REV 36MM 65 DEG POLY LNR +0
|
Facility
|
IP
|
$8,185.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.17 |
| Max. Negotiated Rate |
$7,858.50 |
| Rate for Payer: Aetna Commercial |
$6,303.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,385.03
|
| Rate for Payer: Cash Price |
$4,092.97
|
| Rate for Payer: Cigna Commercial |
$6,794.33
|
| Rate for Payer: First Health Commercial |
$7,776.64
|
| Rate for Payer: Humana Commercial |
$6,958.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,041.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.64
|
| Rate for Payer: PHCS Commercial |
$7,858.50
|
| Rate for Payer: United Healthcare All Payer |
$7,203.63
|
|
|
TM REV 36MM 65 DEG POLY LNR +3
|
Facility
|
OP
|
$8,185.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.17 |
| Max. Negotiated Rate |
$7,858.50 |
| Rate for Payer: Aetna Commercial |
$6,303.17
|
| Rate for Payer: Anthem Medicaid |
$2,815.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,385.03
|
| Rate for Payer: Cash Price |
$4,092.97
|
| Rate for Payer: Cigna Commercial |
$6,794.33
|
| Rate for Payer: First Health Commercial |
$7,776.64
|
| Rate for Payer: Humana Commercial |
$6,958.05
|
| Rate for Payer: Humana KY Medicaid |
$2,815.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,041.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,871.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.64
|
| Rate for Payer: PHCS Commercial |
$7,858.50
|
| Rate for Payer: United Healthcare All Payer |
$7,203.63
|
|
|
TM REV 36MM 65 DEG POLY LNR +3
|
Facility
|
IP
|
$8,185.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.17 |
| Max. Negotiated Rate |
$7,858.50 |
| Rate for Payer: Aetna Commercial |
$6,303.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,385.03
|
| Rate for Payer: Cash Price |
$4,092.97
|
| Rate for Payer: Cigna Commercial |
$6,794.33
|
| Rate for Payer: First Health Commercial |
$7,776.64
|
| Rate for Payer: Humana Commercial |
$6,958.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,041.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.64
|
| Rate for Payer: PHCS Commercial |
$7,858.50
|
| Rate for Payer: United Healthcare All Payer |
$7,203.63
|
|
|
TM REV 36MM 65 DEG POLY LNR +6
|
Facility
|
OP
|
$8,185.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.17 |
| Max. Negotiated Rate |
$7,858.50 |
| Rate for Payer: Aetna Commercial |
$6,303.17
|
| Rate for Payer: Anthem Medicaid |
$2,815.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,385.03
|
| Rate for Payer: Cash Price |
$4,092.97
|
| Rate for Payer: Cigna Commercial |
$6,794.33
|
| Rate for Payer: First Health Commercial |
$7,776.64
|
| Rate for Payer: Humana Commercial |
$6,958.05
|
| Rate for Payer: Humana KY Medicaid |
$2,815.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,041.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,871.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.64
|
| Rate for Payer: PHCS Commercial |
$7,858.50
|
| Rate for Payer: United Healthcare All Payer |
$7,203.63
|
|
|
TM REV 36MM 65 DEG POLY LNR +6
|
Facility
|
IP
|
$8,185.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.17 |
| Max. Negotiated Rate |
$7,858.50 |
| Rate for Payer: Aetna Commercial |
$6,303.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,385.03
|
| Rate for Payer: Cash Price |
$4,092.97
|
| Rate for Payer: Cigna Commercial |
$6,794.33
|
| Rate for Payer: First Health Commercial |
$7,776.64
|
| Rate for Payer: Humana Commercial |
$6,958.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,041.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.64
|
| Rate for Payer: PHCS Commercial |
$7,858.50
|
| Rate for Payer: United Healthcare All Payer |
$7,203.63
|
|
|
TM REV 36MM 65 RTNT POLY LNR+0
|
Facility
|
IP
|
$7,716.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.15 |
| Max. Negotiated Rate |
$7,407.89 |
| Rate for Payer: Aetna Commercial |
$5,941.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,018.91
|
| Rate for Payer: Cash Price |
$3,858.28
|
| Rate for Payer: Cigna Commercial |
$6,404.74
|
| Rate for Payer: First Health Commercial |
$7,330.72
|
| Rate for Payer: Humana Commercial |
$6,559.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,327.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,694.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,314.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,790.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,787.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.13
|
| Rate for Payer: PHCS Commercial |
$7,407.89
|
| Rate for Payer: United Healthcare All Payer |
$6,790.56
|
|
