|
TRAB MTAL REVISION SHELL 54 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 54 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 56 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 56 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 58 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 58 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 60 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 60 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 62 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 62 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 64 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 64 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 66 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 66 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 68 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 68 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 70 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 70 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 72 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 72 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 74 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 74 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 76 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 76 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 78 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
