|
HUMALOG 5 U (100 U/ML)
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem Medicaid |
$21.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.14
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Humana KY Medicaid |
$21.67
|
| Rate for Payer: Kentucky WC Medicaid |
$21.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
HUMALOG 5 U (100 U/ML IV ADDT)
|
Facility
|
OP
|
$63.33
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$48.76
|
| Rate for Payer: Anthem Medicaid |
$21.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.40
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna Commercial |
$52.56
|
| Rate for Payer: First Health Commercial |
$60.16
|
| Rate for Payer: Humana Commercial |
$53.83
|
| Rate for Payer: Humana KY Medicaid |
$21.78
|
| Rate for Payer: Kentucky WC Medicaid |
$22.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.73
|
| Rate for Payer: Ohio Health Group HMO |
$47.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.63
|
| Rate for Payer: PHCS Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Payer |
$55.73
|
|
|
HUMALOG 5 U (100 U/ML IV ADDT)
|
Facility
|
IP
|
$63.33
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$48.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.40
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cigna Commercial |
$52.56
|
| Rate for Payer: First Health Commercial |
$60.16
|
| Rate for Payer: Humana Commercial |
$53.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.73
|
| Rate for Payer: Ohio Health Group HMO |
$47.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.63
|
| Rate for Payer: PHCS Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Payer |
$55.73
|
|
|
HUMALOG 5 UNIMIX 75-25 VL3ML]
|
Facility
|
IP
|
$173.42
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$133.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.27
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna Commercial |
$143.94
|
| Rate for Payer: First Health Commercial |
$164.75
|
| Rate for Payer: Humana Commercial |
$147.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.61
|
| Rate for Payer: Ohio Health Group HMO |
$130.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.76
|
| Rate for Payer: PHCS Commercial |
$166.48
|
| Rate for Payer: United Healthcare All Payer |
$152.61
|
|
|
HUMALOG 5 UNIMIX 75-25 VL3ML]
|
Facility
|
OP
|
$173.42
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$133.53
|
| Rate for Payer: Anthem Medicaid |
$59.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.27
|
| Rate for Payer: Cash Price |
$86.71
|
| Rate for Payer: Cigna Commercial |
$143.94
|
| Rate for Payer: First Health Commercial |
$164.75
|
| Rate for Payer: Humana Commercial |
$147.41
|
| Rate for Payer: Humana KY Medicaid |
$59.64
|
| Rate for Payer: Kentucky WC Medicaid |
$60.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$127.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$152.61
|
| Rate for Payer: Ohio Health Group HMO |
$130.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.76
|
| Rate for Payer: PHCS Commercial |
$166.48
|
| Rate for Payer: United Healthcare All Payer |
$152.61
|
|
|
HUMALOG MIX 50/50 VIAL 10ML
|
Facility
|
OP
|
$465.48
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.51 |
| Max. Negotiated Rate |
$446.86 |
| Rate for Payer: Aetna Commercial |
$358.42
|
| Rate for Payer: Anthem Medicaid |
$160.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.07
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Cigna Commercial |
$386.35
|
| Rate for Payer: First Health Commercial |
$442.21
|
| Rate for Payer: Humana Commercial |
$395.66
|
| Rate for Payer: Humana KY Medicaid |
$160.08
|
| Rate for Payer: Kentucky WC Medicaid |
$161.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.62
|
| Rate for Payer: Ohio Health Group HMO |
$349.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.30
|
| Rate for Payer: PHCS Commercial |
$446.86
|
| Rate for Payer: United Healthcare All Payer |
$409.62
|
|
|
HUMALOG MIX 50/50 VIAL 10ML
|
Facility
|
IP
|
$465.48
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.51 |
| Max. Negotiated Rate |
$446.86 |
| Rate for Payer: Aetna Commercial |
$358.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$363.07
|
| Rate for Payer: Cash Price |
$232.74
|
| Rate for Payer: Cigna Commercial |
$386.35
|
| Rate for Payer: First Health Commercial |
$442.21
|
| Rate for Payer: Humana Commercial |
$395.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$381.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$343.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$409.62
|
| Rate for Payer: Ohio Health Group HMO |
$349.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.30
|
| Rate for Payer: PHCS Commercial |
$446.86
|
| Rate for Payer: United Healthcare All Payer |
$409.62
|
|
|
HUMATE-P 1iuVFW (1200iuVWFSDV)
|
Facility
|
IP
|
$5,545.92
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
25004013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$720.97 |
| Max. Negotiated Rate |
$5,324.08 |
| Rate for Payer: Aetna Commercial |
$4,270.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,325.82
|
| Rate for Payer: Cash Price |
$2,772.96
|
| Rate for Payer: Cigna Commercial |
$4,603.11
|
| Rate for Payer: First Health Commercial |
$5,268.62
|
| Rate for Payer: Humana Commercial |
$4,714.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,547.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,092.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,880.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,159.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,109.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,719.24
|
| Rate for Payer: PHCS Commercial |
$5,324.08
|
| Rate for Payer: United Healthcare All Payer |
$4,880.41
|
|
|
HUMATE-P 1iuVFW (1200iuVWFSDV)
|
Facility
|
OP
|
$5,545.92
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
25004013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$5,324.08 |
| Rate for Payer: Aetna Commercial |
$4,270.36
|
| Rate for Payer: Anthem Medicaid |
$1,907.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,325.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.82
|
| Rate for Payer: Cash Price |
$2,772.96
|
| Rate for Payer: Cash Price |
$2,772.96
|
| Rate for Payer: Cigna Commercial |
$4,603.11
|
| Rate for Payer: First Health Commercial |
$5,268.62
|
| Rate for Payer: Humana Commercial |
$4,714.03
|
| Rate for Payer: Humana KY Medicaid |
$1,907.24
|
| Rate for Payer: Humana Medicare Advantage |
$1.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,926.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,547.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,092.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,945.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,880.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,159.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,109.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,719.24
|
| Rate for Payer: PHCS Commercial |
$5,324.08
|
| Rate for Payer: United Healthcare All Payer |
$4,880.41
|
|
|
HUMATE-P 1iuVWF (2400iuVWFSDV)
|
Facility
|
IP
|
$11,039.19
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
25004014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,435.09 |
| Max. Negotiated Rate |
$10,597.62 |
| Rate for Payer: Aetna Commercial |
$8,500.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,610.57
|
| Rate for Payer: Cash Price |
$5,519.60
|
| Rate for Payer: Cigna Commercial |
$9,162.53
|
| Rate for Payer: First Health Commercial |
$10,487.23
|
| Rate for Payer: Humana Commercial |
$9,383.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,052.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,146.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,311.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,714.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,279.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,207.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,422.15
|
| Rate for Payer: PHCS Commercial |
$10,597.62
|
| Rate for Payer: United Healthcare All Payer |
$9,714.49
|
|
|
HUMATE-P 1iuVWF (2400iuVWFSDV)
|
Facility
|
OP
|
$11,039.19
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
25004014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$10,597.62 |
| Rate for Payer: Aetna Commercial |
$8,500.18
|
| Rate for Payer: Anthem Medicaid |
$3,796.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,610.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.82
|
| Rate for Payer: Cash Price |
$5,519.60
|
| Rate for Payer: Cash Price |
$5,519.60
|
| Rate for Payer: Cigna Commercial |
$9,162.53
|
| Rate for Payer: First Health Commercial |
$10,487.23
|
| Rate for Payer: Humana Commercial |
$9,383.31
|
| Rate for Payer: Humana KY Medicaid |
$3,796.38
|
| Rate for Payer: Humana Medicare Advantage |
$1.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,835.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,052.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,146.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,872.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,714.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,279.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,207.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,422.15
|
| Rate for Payer: PHCS Commercial |
$10,597.62
|
| Rate for Payer: United Healthcare All Payer |
$9,714.49
|
|
|
HUMATE-P 1iuVWF (600iuVWF SDV)
|
Facility
|
IP
|
$2,840.65
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
25004012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$369.28 |
| Max. Negotiated Rate |
$2,727.02 |
| Rate for Payer: Aetna Commercial |
$2,187.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.71
|
| Rate for Payer: Cash Price |
$1,420.33
|
| Rate for Payer: Cigna Commercial |
$2,357.74
|
| Rate for Payer: First Health Commercial |
$2,698.62
|
| Rate for Payer: Humana Commercial |
$2,414.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,329.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,096.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,499.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.60
|
| Rate for Payer: PHCS Commercial |
$2,727.02
|
| Rate for Payer: United Healthcare All Payer |
$2,499.77
|
|
|
HUMATE-P 1iuVWF (600iuVWF SDV)
|
Facility
|
OP
|
$2,840.65
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
25004012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2,727.02 |
| Rate for Payer: Aetna Commercial |
$2,187.30
|
| Rate for Payer: Anthem Medicaid |
$976.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.82
|
| Rate for Payer: Cash Price |
$1,420.33
|
| Rate for Payer: Cash Price |
$1,420.33
|
| Rate for Payer: Cigna Commercial |
$2,357.74
|
| Rate for Payer: First Health Commercial |
$2,698.62
|
| Rate for Payer: Humana Commercial |
$2,414.55
|
| Rate for Payer: Humana KY Medicaid |
$976.90
|
| Rate for Payer: Humana Medicare Advantage |
$1.35
|
| Rate for Payer: Kentucky WC Medicaid |
$986.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,329.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,096.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$996.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,499.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.60
|
| Rate for Payer: PHCS Commercial |
$2,727.02
|
| Rate for Payer: United Healthcare All Payer |
$2,499.77
|
|
|
HUMERAL 100MM STD.
|
Facility
|
OP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem Medicaid |
$9,106.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Humana KY Medicaid |
$9,106.82
|
| Rate for Payer: Kentucky WC Medicaid |
$9,199.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,289.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
HUMERAL 100MM STD.
|
Facility
|
IP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
HUMERAL ASSEMBLY LRG LEFT
|
Facility
|
IP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY LRG LEFT
|
Facility
|
OP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem Medicaid |
$5,660.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Humana KY Medicaid |
$5,660.65
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY LRG L LG STEM
|
Facility
|
IP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY LRG L LG STEM
|
Facility
|
OP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem Medicaid |
$5,660.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Humana KY Medicaid |
$5,660.65
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY LRG R LG STEM
|
Facility
|
IP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY LRG R LG STEM
|
Facility
|
OP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem Medicaid |
$5,660.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Humana KY Medicaid |
$5,660.65
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY LRG RT 89MM
|
Facility
|
OP
|
$20,638.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.95 |
| Max. Negotiated Rate |
$19,812.56 |
| Rate for Payer: Aetna Commercial |
$15,891.32
|
| Rate for Payer: Anthem Medicaid |
$7,097.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,097.70
|
| Rate for Payer: Cash Price |
$10,319.04
|
| Rate for Payer: Cigna Commercial |
$17,129.61
|
| Rate for Payer: First Health Commercial |
$19,606.18
|
| Rate for Payer: Humana Commercial |
$17,542.37
|
| Rate for Payer: Humana KY Medicaid |
$7,097.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,169.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,923.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,230.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,191.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,239.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,161.51
|
| Rate for Payer: Ohio Health Group HMO |
$15,478.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,127.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,397.80
|
| Rate for Payer: PHCS Commercial |
$19,812.56
|
| Rate for Payer: United Healthcare All Payer |
$18,161.51
|
|
|
HUMERAL ASSEMBLY LRG RT 89MM
|
Facility
|
IP
|
$20,638.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.95 |
| Max. Negotiated Rate |
$19,812.56 |
| Rate for Payer: Aetna Commercial |
$15,891.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,097.70
|
| Rate for Payer: Cash Price |
$10,319.04
|
| Rate for Payer: Cigna Commercial |
$17,129.61
|
| Rate for Payer: First Health Commercial |
$19,606.18
|
| Rate for Payer: Humana Commercial |
$17,542.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,923.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,230.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,191.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,161.51
|
| Rate for Payer: Ohio Health Group HMO |
$15,478.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,127.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,397.80
|
| Rate for Payer: PHCS Commercial |
$19,812.56
|
| Rate for Payer: United Healthcare All Payer |
$18,161.51
|
|
|
HUMERAL ASSEMBLY STD LEFT
|
Facility
|
OP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem Medicaid |
$5,660.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Humana KY Medicaid |
$5,660.65
|
| Rate for Payer: Kentucky WC Medicaid |
$5,718.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,774.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
|
HUMERAL ASSEMBLY STD LEFT
|
Facility
|
IP
|
$16,460.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,139.82 |
| Max. Negotiated Rate |
$15,801.75 |
| Rate for Payer: Aetna Commercial |
$12,674.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,838.92
|
| Rate for Payer: Cash Price |
$8,230.08
|
| Rate for Payer: Cigna Commercial |
$13,661.93
|
| Rate for Payer: First Health Commercial |
$15,637.15
|
| Rate for Payer: Humana Commercial |
$13,991.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,497.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,938.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,484.94
|
| Rate for Payer: Ohio Health Group HMO |
$12,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,292.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,139.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.65
|
| Rate for Payer: PHCS Commercial |
$15,801.75
|
| Rate for Payer: United Healthcare All Payer |
$14,484.94
|
|
