|
HUMERAL COMP 56MM*52MM 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 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 58MM*54MM 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 58MM*54MM 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 58MM*54MM 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 58MM*54MM 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 HD 15MMX40MM
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
HUMERAL HD 15MMX40MM
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
HUMERAL HD 15MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 15MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 18MMX40MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 18MMX40MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 18MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 18MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 18MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 18MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 21MMX40MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 21MMX40MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 21MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 21MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 21MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 21MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 24MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 24MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 24MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
