|
HUMERAL CEM EPIPHYSIS 36.2
|
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 42.1
|
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 42.1
|
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 COMP 46MM*42MM OVO
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 46MM*42MM OVO
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 46MM*42MM OVO CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 46MM*42MM OVO CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 48MM*44MM OVO
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 48MM*44MM OVO
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 48MM*44MM OVO CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 48MM*44MM OVO CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 50MM*46MM OVO
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 50MM*46MM OVO
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 50MM*46MM OVO CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 50MM*46MM OVO CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 52MM*48MM OVO
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 52MM*48MM OVO
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 52MM*48MM OVO CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 52MM*48MM OVO CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 54MM*50MM OVO
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 54MM*50MM OVO
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 54MM*50MM OVO CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 54MM*50MM OVO CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 56MM*52MM OVO
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
HUMERAL COMP 56MM*52MM OVO
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
