|
BF HUMERAL STEM 7*60
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 8*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 8*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 8*170
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 8*170
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 8*200
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 8*200
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 9*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 9*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
B/F HUM HEAD RESECTION GU
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
B/F HUM HEAD RESECTION GU
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
BF HUM STEM 10*200
|
Facility
|
OP
|
$22,160.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.23 |
| Max. Negotiated Rate |
$21,274.32 |
| Rate for Payer: Aetna Commercial |
$17,063.78
|
| Rate for Payer: Anthem Medicaid |
$7,621.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,285.38
|
| Rate for Payer: Cash Price |
$11,080.38
|
| Rate for Payer: Cigna Commercial |
$18,393.42
|
| Rate for Payer: First Health Commercial |
$21,052.71
|
| Rate for Payer: Humana Commercial |
$18,836.64
|
| Rate for Payer: Humana KY Medicaid |
$7,621.08
|
| Rate for Payer: Kentucky WC Medicaid |
$7,698.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,773.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,501.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.92
|
| Rate for Payer: PHCS Commercial |
$21,274.32
|
| Rate for Payer: United Healthcare All Payer |
$19,501.46
|
|
|
BF HUM STEM 10*200
|
Facility
|
IP
|
$22,160.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.23 |
| Max. Negotiated Rate |
$21,274.32 |
| Rate for Payer: Aetna Commercial |
$17,063.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,285.38
|
| Rate for Payer: Cash Price |
$11,080.38
|
| Rate for Payer: Cigna Commercial |
$18,393.42
|
| Rate for Payer: First Health Commercial |
$21,052.71
|
| Rate for Payer: Humana Commercial |
$18,836.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,501.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.92
|
| Rate for Payer: PHCS Commercial |
$21,274.32
|
| Rate for Payer: United Healthcare All Payer |
$19,501.46
|
|
|
BF HUM STEM 12*200
|
Facility
|
OP
|
$22,160.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.23 |
| Max. Negotiated Rate |
$21,274.32 |
| Rate for Payer: Aetna Commercial |
$17,063.78
|
| Rate for Payer: Anthem Medicaid |
$7,621.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,285.38
|
| Rate for Payer: Cash Price |
$11,080.38
|
| Rate for Payer: Cigna Commercial |
$18,393.42
|
| Rate for Payer: First Health Commercial |
$21,052.71
|
| Rate for Payer: Humana Commercial |
$18,836.64
|
| Rate for Payer: Humana KY Medicaid |
$7,621.08
|
| Rate for Payer: Kentucky WC Medicaid |
$7,698.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,773.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,501.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.92
|
| Rate for Payer: PHCS Commercial |
$21,274.32
|
| Rate for Payer: United Healthcare All Payer |
$19,501.46
|
|
|
BF HUM STEM 12*200
|
Facility
|
IP
|
$22,160.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.23 |
| Max. Negotiated Rate |
$21,274.32 |
| Rate for Payer: Aetna Commercial |
$17,063.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,285.38
|
| Rate for Payer: Cash Price |
$11,080.38
|
| Rate for Payer: Cigna Commercial |
$18,393.42
|
| Rate for Payer: First Health Commercial |
$21,052.71
|
| Rate for Payer: Humana Commercial |
$18,836.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,501.46
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.92
|
| Rate for Payer: PHCS Commercial |
$21,274.32
|
| Rate for Payer: United Healthcare All Payer |
$19,501.46
|
|
|
BF HUM STEM 14*200
|
Facility
|
OP
|
$22,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.00 |
| Max. Negotiated Rate |
$21,273.60 |
| Rate for Payer: Aetna Commercial |
$17,063.20
|
| Rate for Payer: Anthem Medicaid |
$7,620.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,284.80
|
| Rate for Payer: Cash Price |
$11,080.00
|
| Rate for Payer: Cigna Commercial |
$18,392.80
|
| Rate for Payer: First Health Commercial |
$21,052.00
|
| Rate for Payer: Humana Commercial |
$18,836.00
|
| Rate for Payer: Humana KY Medicaid |
$7,620.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,698.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,773.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,500.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.40
|
| Rate for Payer: PHCS Commercial |
$21,273.60
|
| Rate for Payer: United Healthcare All Payer |
$19,500.80
|
|
|
BF HUM STEM 14*200
|
Facility
|
IP
|
$22,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.00 |
| Max. Negotiated Rate |
$21,273.60 |
| Rate for Payer: Aetna Commercial |
$17,063.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,284.80
|
| Rate for Payer: Cash Price |
$11,080.00
|
| Rate for Payer: Cigna Commercial |
$18,392.80
|
| Rate for Payer: First Health Commercial |
$21,052.00
|
| Rate for Payer: Humana Commercial |
$18,836.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,500.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.40
|
| Rate for Payer: PHCS Commercial |
$21,273.60
|
| Rate for Payer: United Healthcare All Payer |
$19,500.80
|
|
|
BF HUM STEM 8*200
|
Facility
|
IP
|
$22,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.00 |
| Max. Negotiated Rate |
$21,273.60 |
| Rate for Payer: Aetna Commercial |
$17,063.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,284.80
|
| Rate for Payer: Cash Price |
$11,080.00
|
| Rate for Payer: Cigna Commercial |
$18,392.80
|
| Rate for Payer: First Health Commercial |
$21,052.00
|
| Rate for Payer: Humana Commercial |
$18,836.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,500.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.40
|
| Rate for Payer: PHCS Commercial |
$21,273.60
|
| Rate for Payer: United Healthcare All Payer |
$19,500.80
|
|
|
BF HUM STEM 8*200
|
Facility
|
OP
|
$22,160.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,648.00 |
| Max. Negotiated Rate |
$21,273.60 |
| Rate for Payer: Aetna Commercial |
$17,063.20
|
| Rate for Payer: Anthem Medicaid |
$7,620.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,284.80
|
| Rate for Payer: Cash Price |
$11,080.00
|
| Rate for Payer: Cigna Commercial |
$18,392.80
|
| Rate for Payer: First Health Commercial |
$21,052.00
|
| Rate for Payer: Humana Commercial |
$18,836.00
|
| Rate for Payer: Humana KY Medicaid |
$7,620.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,698.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,171.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,354.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,648.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,773.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,500.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,620.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,279.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,290.40
|
| Rate for Payer: PHCS Commercial |
$21,273.60
|
| Rate for Payer: United Healthcare All Payer |
$19,500.80
|
|
|
BF KEELED GLENOID 40MM
|
Facility
|
IP
|
$9,359.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.93 |
| Max. Negotiated Rate |
$8,985.37 |
| Rate for Payer: Aetna Commercial |
$7,207.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,300.61
|
| Rate for Payer: Cash Price |
$4,679.88
|
| Rate for Payer: Cigna Commercial |
$7,768.60
|
| Rate for Payer: First Health Commercial |
$8,891.77
|
| Rate for Payer: Humana Commercial |
$7,955.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,675.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,907.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,236.59
|
| Rate for Payer: Ohio Health Group HMO |
$7,019.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,487.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,142.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,458.23
|
| Rate for Payer: PHCS Commercial |
$8,985.37
|
| Rate for Payer: United Healthcare All Payer |
$8,236.59
|
|
|
BF KEELED GLENOID 40MM
|
Facility
|
OP
|
$9,359.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.93 |
| Max. Negotiated Rate |
$8,985.37 |
| Rate for Payer: Aetna Commercial |
$7,207.02
|
| Rate for Payer: Anthem Medicaid |
$3,218.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,300.61
|
| Rate for Payer: Cash Price |
$4,679.88
|
| Rate for Payer: Cigna Commercial |
$7,768.60
|
| Rate for Payer: First Health Commercial |
$8,891.77
|
| Rate for Payer: Humana Commercial |
$7,955.80
|
| Rate for Payer: Humana KY Medicaid |
$3,218.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,675.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,907.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,283.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,236.59
|
| Rate for Payer: Ohio Health Group HMO |
$7,019.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,487.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,142.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,458.23
|
| Rate for Payer: PHCS Commercial |
$8,985.37
|
| Rate for Payer: United Healthcare All Payer |
$8,236.59
|
|
|
BF KEELED GLENOID 46MM
|
Facility
|
IP
|
$9,359.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.93 |
| Max. Negotiated Rate |
$8,985.37 |
| Rate for Payer: Aetna Commercial |
$7,207.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,300.61
|
| Rate for Payer: Cash Price |
$4,679.88
|
| Rate for Payer: Cigna Commercial |
$7,768.60
|
| Rate for Payer: First Health Commercial |
$8,891.77
|
| Rate for Payer: Humana Commercial |
$7,955.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,675.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,907.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,236.59
|
| Rate for Payer: Ohio Health Group HMO |
$7,019.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,487.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,142.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,458.23
|
| Rate for Payer: PHCS Commercial |
$8,985.37
|
| Rate for Payer: United Healthcare All Payer |
$8,236.59
|
|
|
BF KEELED GLENOID 46MM
|
Facility
|
OP
|
$9,359.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.93 |
| Max. Negotiated Rate |
$8,985.37 |
| Rate for Payer: Aetna Commercial |
$7,207.02
|
| Rate for Payer: Anthem Medicaid |
$3,218.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,300.61
|
| Rate for Payer: Cash Price |
$4,679.88
|
| Rate for Payer: Cigna Commercial |
$7,768.60
|
| Rate for Payer: First Health Commercial |
$8,891.77
|
| Rate for Payer: Humana Commercial |
$7,955.80
|
| Rate for Payer: Humana KY Medicaid |
$3,218.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,675.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,907.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,283.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,236.59
|
| Rate for Payer: Ohio Health Group HMO |
$7,019.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,487.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,142.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,458.23
|
| Rate for Payer: PHCS Commercial |
$8,985.37
|
| Rate for Payer: United Healthcare All Payer |
$8,236.59
|
|
|
BF KEELED GLENOID 52MM
|
Facility
|
OP
|
$9,359.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.93 |
| Max. Negotiated Rate |
$8,985.37 |
| Rate for Payer: Aetna Commercial |
$7,207.02
|
| Rate for Payer: Anthem Medicaid |
$3,218.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,300.61
|
| Rate for Payer: Cash Price |
$4,679.88
|
| Rate for Payer: Cigna Commercial |
$7,768.60
|
| Rate for Payer: First Health Commercial |
$8,891.77
|
| Rate for Payer: Humana Commercial |
$7,955.80
|
| Rate for Payer: Humana KY Medicaid |
$3,218.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,675.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,907.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,283.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,236.59
|
| Rate for Payer: Ohio Health Group HMO |
$7,019.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,487.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,142.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,458.23
|
| Rate for Payer: PHCS Commercial |
$8,985.37
|
| Rate for Payer: United Healthcare All Payer |
$8,236.59
|
|
|
BF KEELED GLENOID 52MM
|
Facility
|
IP
|
$9,359.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.93 |
| Max. Negotiated Rate |
$8,985.37 |
| Rate for Payer: Aetna Commercial |
$7,207.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,300.61
|
| Rate for Payer: Cash Price |
$4,679.88
|
| Rate for Payer: Cigna Commercial |
$7,768.60
|
| Rate for Payer: First Health Commercial |
$8,891.77
|
| Rate for Payer: Humana Commercial |
$7,955.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,675.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,907.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,236.59
|
| Rate for Payer: Ohio Health Group HMO |
$7,019.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,487.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,142.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,458.23
|
| Rate for Payer: PHCS Commercial |
$8,985.37
|
| Rate for Payer: United Healthcare All Payer |
$8,236.59
|
|
