|
BF OFFSET HUM HEAD 27*40
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*40
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*52
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*52
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 27*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 30*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 30*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 30*52
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 30*52
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 30*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 30*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 33*52
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 33*52
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 33*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 33*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF PEGGED 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 PEGGED 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 PEGGED 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 PEGGED 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 PEGGED 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
|
|
|
BF PEGGED 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
|
|
|
BHR-2MM ACE CUO HAP SZ 48/54
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
