|
TM FEM METAPHYSEAL CONE 35 SML
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METAPHYSEAL CONE 35 SML
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METAPHYSEAL CONE 35 SMR
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METAPHYSEAL CONE 35 SMR
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METPHYSL CONE 35 MED L
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METPHYSL CONE 35 MED L
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METPHYSL CONE 35 MED R
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM FEM METPHYSL CONE 35 MED R
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TM GLENOD 40MM * 46MM ART SURF
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 40MM * 46MM ART SURF
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 46MM * 40MM ART SURF
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 46MM * 40MM ART SURF
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 46MM * 52MM ART SURF
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 46MM * 52MM ART SURF
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 52MM * 46MM ART SURF
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 52MM * 46MM ART SURF
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 52MM * 56MM ART SURF
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 52MM * 56MM ART SURF
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOD 6MM DRIL W/STOP STR
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
TM GLENOD 6MM DRIL W/STOP STR
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
TM GLENOID 40MM
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOID 40MM
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOID 52MM
|
Facility
|
IP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOID 52MM
|
Facility
|
OP
|
$11,606.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,481.89 |
| Max. Negotiated Rate |
$11,142.05 |
| Rate for Payer: Aetna Commercial |
$8,936.85
|
| Rate for Payer: Anthem Medicaid |
$3,991.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,052.91
|
| Rate for Payer: Cash Price |
$5,803.15
|
| Rate for Payer: Cigna Commercial |
$9,633.23
|
| Rate for Payer: First Health Commercial |
$11,025.99
|
| Rate for Payer: Humana Commercial |
$9,865.35
|
| Rate for Payer: Humana KY Medicaid |
$3,991.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,517.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,565.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,481.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,071.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,213.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,704.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,285.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,097.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,008.35
|
| Rate for Payer: PHCS Commercial |
$11,142.05
|
| Rate for Payer: United Healthcare All Payer |
$10,213.54
|
|
|
TM GLENOID IMPLANT SET
|
Facility
|
OP
|
$102,368.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30,710.64 |
| Max. Negotiated Rate |
$98,274.05 |
| Rate for Payer: Aetna Commercial |
$78,823.98
|
| Rate for Payer: Anthem Medicaid |
$35,204.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79,847.66
|
| Rate for Payer: Cash Price |
$51,184.40
|
| Rate for Payer: Cigna Commercial |
$84,966.10
|
| Rate for Payer: First Health Commercial |
$97,250.36
|
| Rate for Payer: Humana Commercial |
$87,013.48
|
| Rate for Payer: Humana KY Medicaid |
$35,204.63
|
| Rate for Payer: Kentucky WC Medicaid |
$35,562.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83,942.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75,548.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,710.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,910.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$90,084.54
|
| Rate for Payer: Ohio Health Group HMO |
$76,776.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81,895.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89,060.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70,634.47
|
| Rate for Payer: PHCS Commercial |
$98,274.05
|
| Rate for Payer: United Healthcare All Payer |
$90,084.54
|
|
