|
HUMERAL ASSEMBLY STD 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 STD 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: 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 STD RIGHT
|
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 STD RIGHT
|
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 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 STD 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 ASSY TOT ELBOW SM 4
|
Facility
|
OP
|
$24,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,186.30 |
| Max. Negotiated Rate |
$23,529.60 |
| Rate for Payer: Aetna Commercial |
$18,872.70
|
| Rate for Payer: Anthem Medicaid |
$8,428.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,117.80
|
| Rate for Payer: Cash Price |
$12,255.00
|
| Rate for Payer: Cigna Commercial |
$20,343.30
|
| Rate for Payer: First Health Commercial |
$23,284.50
|
| Rate for Payer: Humana Commercial |
$20,833.50
|
| Rate for Payer: Humana KY Medicaid |
$8,428.99
|
| Rate for Payer: Kentucky WC Medicaid |
$8,514.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,098.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,353.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,598.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,568.80
|
| Rate for Payer: Ohio Health Group HMO |
$18,382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,186.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,598.10
|
| Rate for Payer: PHCS Commercial |
$23,529.60
|
| Rate for Payer: United Healthcare All Payer |
$21,568.80
|
|
|
HUMERAL ASSY TOT ELBOW SM 4
|
Facility
|
IP
|
$24,510.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,186.30 |
| Max. Negotiated Rate |
$23,529.60 |
| Rate for Payer: Aetna Commercial |
$18,872.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,117.80
|
| Rate for Payer: Cash Price |
$12,255.00
|
| Rate for Payer: Cigna Commercial |
$20,343.30
|
| Rate for Payer: First Health Commercial |
$23,284.50
|
| Rate for Payer: Humana Commercial |
$20,833.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,098.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,088.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,353.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,568.80
|
| Rate for Payer: Ohio Health Group HMO |
$18,382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,186.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,598.10
|
| Rate for Payer: PHCS Commercial |
$23,529.60
|
| Rate for Payer: United Healthcare All Payer |
$21,568.80
|
|
|
HUMERAL BEARNG/BUSHING KIT LRG
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
HUMERAL BEARNG/BUSHING KIT LRG
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
HUMERAL BEARNG/BUSHING KIT STD
|
Facility
|
OP
|
$4,610.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.40 |
| Max. Negotiated Rate |
$4,426.37 |
| Rate for Payer: Aetna Commercial |
$3,550.32
|
| Rate for Payer: Anthem Medicaid |
$1,585.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,596.42
|
| Rate for Payer: Cash Price |
$2,305.40
|
| Rate for Payer: Cigna Commercial |
$3,826.96
|
| Rate for Payer: First Health Commercial |
$4,380.26
|
| Rate for Payer: Humana Commercial |
$3,919.18
|
| Rate for Payer: Humana KY Medicaid |
$1,585.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,601.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,780.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,402.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,383.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,617.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,057.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.35
|
| Rate for Payer: PHCS Commercial |
$4,426.37
|
| Rate for Payer: United Healthcare All Payer |
$4,057.50
|
|
|
HUMERAL BEARNG/BUSHING KIT STD
|
Facility
|
IP
|
$4,610.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.40 |
| Max. Negotiated Rate |
$4,426.37 |
| Rate for Payer: Aetna Commercial |
$3,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,596.42
|
| Rate for Payer: Cash Price |
$2,305.40
|
| Rate for Payer: Cigna Commercial |
$3,826.96
|
| Rate for Payer: First Health Commercial |
$4,380.26
|
| Rate for Payer: Humana Commercial |
$3,919.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,780.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,402.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,383.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,057.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.35
|
| Rate for Payer: PHCS Commercial |
$4,426.37
|
| Rate for Payer: United Healthcare All Payer |
$4,057.50
|
|
|
HUMERAL CEM DIAPHYSIS SZ 0 L85
|
Facility
|
OP
|
$23,209.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,017.19 |
| Max. Negotiated Rate |
$22,280.77 |
| Rate for Payer: Aetna Commercial |
$17,871.04
|
| Rate for Payer: Anthem Medicaid |
$7,981.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,103.13
|
| Rate for Payer: Cash Price |
$11,604.57
|
| Rate for Payer: Cigna Commercial |
$19,263.59
|
| Rate for Payer: First Health Commercial |
$22,048.68
|
| Rate for Payer: Humana Commercial |
$19,727.77
|
| Rate for Payer: Humana KY Medicaid |
$7,981.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,062.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,031.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,128.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,962.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,141.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,424.04
|
| Rate for Payer: Ohio Health Group HMO |
$17,406.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,641.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,017.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,194.83
|
| Rate for Payer: PHCS Commercial |
$22,280.77
|
| Rate for Payer: United Healthcare All Payer |
$20,424.04
|
|
|
HUMERAL CEM DIAPHYSIS SZ 0 L85
|
Facility
|
IP
|
$23,209.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,017.19 |
| Max. Negotiated Rate |
$22,280.77 |
| Rate for Payer: Aetna Commercial |
$17,871.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,103.13
|
| Rate for Payer: Cash Price |
$11,604.57
|
| Rate for Payer: Cigna Commercial |
$19,263.59
|
| Rate for Payer: First Health Commercial |
$22,048.68
|
| Rate for Payer: Humana Commercial |
$19,727.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,031.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,128.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,962.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,424.04
|
| Rate for Payer: Ohio Health Group HMO |
$17,406.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,641.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,017.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,194.83
|
| Rate for Payer: PHCS Commercial |
$22,280.77
|
| Rate for Payer: United Healthcare All Payer |
$20,424.04
|
|
|
HUMERAL CEM DIAPHYSIS SZ 1 L86
|
Facility
|
IP
|
$8,240.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.24 |
| Max. Negotiated Rate |
$7,910.72 |
| Rate for Payer: Aetna Commercial |
$6,345.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$4,120.16
|
| Rate for Payer: Cigna Commercial |
$6,839.47
|
| Rate for Payer: First Health Commercial |
$7,828.31
|
| Rate for Payer: Humana Commercial |
$7,004.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,757.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,081.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,472.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,251.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,180.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.50
|
| Rate for Payer: PHCS Commercial |
$7,910.72
|
| Rate for Payer: United Healthcare All Payer |
$7,251.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 1 L86
|
Facility
|
OP
|
$8,240.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.24 |
| Max. Negotiated Rate |
$7,910.72 |
| Rate for Payer: Aetna Commercial |
$6,345.05
|
| Rate for Payer: Anthem Medicaid |
$2,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$4,120.16
|
| Rate for Payer: Cigna Commercial |
$6,839.47
|
| Rate for Payer: First Health Commercial |
$7,828.31
|
| Rate for Payer: Humana Commercial |
$7,004.28
|
| Rate for Payer: Humana KY Medicaid |
$2,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,757.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,081.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,472.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,251.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,180.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.50
|
| Rate for Payer: PHCS Commercial |
$7,910.72
|
| Rate for Payer: United Healthcare All Payer |
$7,251.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 2 L88
|
Facility
|
OP
|
$8,240.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.24 |
| Max. Negotiated Rate |
$7,910.72 |
| Rate for Payer: Aetna Commercial |
$6,345.05
|
| Rate for Payer: Anthem Medicaid |
$2,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$4,120.16
|
| Rate for Payer: Cigna Commercial |
$6,839.47
|
| Rate for Payer: First Health Commercial |
$7,828.31
|
| Rate for Payer: Humana Commercial |
$7,004.28
|
| Rate for Payer: Humana KY Medicaid |
$2,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,757.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,081.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,472.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,251.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,180.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.50
|
| Rate for Payer: PHCS Commercial |
$7,910.72
|
| Rate for Payer: United Healthcare All Payer |
$7,251.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 2 L88
|
Facility
|
IP
|
$8,240.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.24 |
| Max. Negotiated Rate |
$7,910.72 |
| Rate for Payer: Aetna Commercial |
$6,345.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$4,120.16
|
| Rate for Payer: Cigna Commercial |
$6,839.47
|
| Rate for Payer: First Health Commercial |
$7,828.31
|
| Rate for Payer: Humana Commercial |
$7,004.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,757.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,081.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,472.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,251.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,180.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.50
|
| Rate for Payer: PHCS Commercial |
$7,910.72
|
| Rate for Payer: United Healthcare All Payer |
$7,251.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 3 L89
|
Facility
|
IP
|
$21,499.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.92 |
| Max. Negotiated Rate |
$20,639.40 |
| Rate for Payer: Aetna Commercial |
$16,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.51
|
| Rate for Payer: Cash Price |
$10,749.69
|
| Rate for Payer: Cigna Commercial |
$17,844.48
|
| Rate for Payer: First Health Commercial |
$20,424.40
|
| Rate for Payer: Humana Commercial |
$18,274.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,629.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,919.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.80
|
| Rate for Payer: PHCS Commercial |
$20,639.40
|
| Rate for Payer: United Healthcare All Payer |
$18,919.45
|
|
|
HUMERAL CEM DIAPHYSIS SZ 3 L89
|
Facility
|
OP
|
$21,499.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.92 |
| Max. Negotiated Rate |
$20,639.40 |
| Rate for Payer: Aetna Commercial |
$16,554.51
|
| Rate for Payer: Anthem Medicaid |
$7,393.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.51
|
| Rate for Payer: Cash Price |
$10,749.69
|
| Rate for Payer: Cigna Commercial |
$17,844.48
|
| Rate for Payer: First Health Commercial |
$20,424.40
|
| Rate for Payer: Humana Commercial |
$18,274.46
|
| Rate for Payer: Humana KY Medicaid |
$7,393.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,468.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,629.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,541.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,919.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.80
|
| Rate for Payer: PHCS Commercial |
$20,639.40
|
| Rate for Payer: United Healthcare All Payer |
$18,919.45
|
|
|
HUMERAL CEM DIAPHYSIS SZ 4 L94
|
Facility
|
IP
|
$8,240.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.24 |
| Max. Negotiated Rate |
$7,910.72 |
| Rate for Payer: Aetna Commercial |
$6,345.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$4,120.16
|
| Rate for Payer: Cigna Commercial |
$6,839.47
|
| Rate for Payer: First Health Commercial |
$7,828.31
|
| Rate for Payer: Humana Commercial |
$7,004.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,757.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,081.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,472.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,251.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,180.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.50
|
| Rate for Payer: PHCS Commercial |
$7,910.72
|
| Rate for Payer: United Healthcare All Payer |
$7,251.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 4 L94
|
Facility
|
OP
|
$8,240.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.24 |
| Max. Negotiated Rate |
$7,910.72 |
| Rate for Payer: Aetna Commercial |
$6,345.05
|
| Rate for Payer: Anthem Medicaid |
$2,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,427.46
|
| Rate for Payer: Cash Price |
$4,120.16
|
| Rate for Payer: Cigna Commercial |
$6,839.47
|
| Rate for Payer: First Health Commercial |
$7,828.31
|
| Rate for Payer: Humana Commercial |
$7,004.28
|
| Rate for Payer: Humana KY Medicaid |
$2,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,862.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,757.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,081.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,472.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,890.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,251.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,180.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,071.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,554.50
|
| Rate for Payer: PHCS Commercial |
$7,910.72
|
| Rate for Payer: United Healthcare All Payer |
$7,251.49
|
|
|
HUMERAL CEM EPIPHYSIS 36.1
|
Facility
|
OP
|
$13,076.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.95 |
| Max. Negotiated Rate |
$12,553.46 |
| Rate for Payer: Aetna Commercial |
$10,068.92
|
| Rate for Payer: Anthem Medicaid |
$4,497.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,199.69
|
| Rate for Payer: Cash Price |
$6,538.26
|
| Rate for Payer: Cigna Commercial |
$10,853.51
|
| Rate for Payer: First Health Commercial |
$12,422.69
|
| Rate for Payer: Humana Commercial |
$11,115.04
|
| Rate for Payer: Humana KY Medicaid |
$4,497.02
|
| Rate for Payer: Kentucky WC Medicaid |
$4,542.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,722.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,650.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,922.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,587.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,507.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,807.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,615.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,053.72
|
| Rate for Payer: PHCS Commercial |
$12,553.46
|
| Rate for Payer: United Healthcare All Payer |
$11,507.34
|
|
|
HUMERAL CEM EPIPHYSIS 36.1
|
Facility
|
IP
|
$13,076.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.95 |
| Max. Negotiated Rate |
$12,553.46 |
| Rate for Payer: Aetna Commercial |
$10,068.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,199.69
|
| Rate for Payer: Cash Price |
$6,538.26
|
| Rate for Payer: Cigna Commercial |
$10,853.51
|
| Rate for Payer: First Health Commercial |
$12,422.69
|
| Rate for Payer: Humana Commercial |
$11,115.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,722.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,650.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,922.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,507.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,807.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,615.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,053.72
|
| Rate for Payer: PHCS Commercial |
$12,553.46
|
| Rate for Payer: United Healthcare All Payer |
$11,507.34
|
|
|
HUMERAL CEM EPIPHYSIS 36.2
|
Facility
|
IP
|
$13,076.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.95 |
| Max. Negotiated Rate |
$12,553.46 |
| Rate for Payer: Aetna Commercial |
$10,068.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,199.69
|
| Rate for Payer: Cash Price |
$6,538.26
|
| Rate for Payer: Cigna Commercial |
$10,853.51
|
| Rate for Payer: First Health Commercial |
$12,422.69
|
| Rate for Payer: Humana Commercial |
$11,115.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,722.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,650.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,922.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,507.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,807.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,615.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,699.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,053.72
|
| Rate for Payer: PHCS Commercial |
$12,553.46
|
| Rate for Payer: United Healthcare All Payer |
$11,507.34
|
|
