|
HUMERAL HD. 42MMX56MM
|
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. 42MMX56MM
|
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 HEAD 40MM*17MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HUMERAL HEAD 40MM*17MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HUMERAL HEAD SOLAR 50MM*18MM
|
Facility
|
IP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
HUMERAL HEAD SOLAR 50MM*18MM
|
Facility
|
OP
|
$7,874.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.74 |
| Max. Negotiated Rate |
$7,559.96 |
| Rate for Payer: Aetna Commercial |
$6,063.72
|
| Rate for Payer: Anthem Medicaid |
$2,708.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.47
|
| Rate for Payer: Cash Price |
$3,937.48
|
| Rate for Payer: Cigna Commercial |
$6,536.22
|
| Rate for Payer: First Health Commercial |
$7,481.21
|
| Rate for Payer: Humana Commercial |
$6,693.72
|
| Rate for Payer: Humana KY Medicaid |
$2,708.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,811.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,929.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.24
|
| Rate for Payer: PHCS Commercial |
$7,559.96
|
| Rate for Payer: United Healthcare All Payer |
$6,929.96
|
|
|
HUMERAL INSERT 33 6
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSERT 33 6
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSERT X3 4MM 36MM
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HUMERAL INSERT X3 4MM 36MM
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HUMERAL INSRT 33+3/36
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT 33+3/36
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT 33+6/36
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT 33+6/36
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT CBO CONST36+3/33
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT CBO CONST36+3/33
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT CBO CONST36+3/39
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT CBO CONST36+3/39
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT CBO CONST36+6/33
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT CBO CONST36+6/33
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT COMBO 36+3/33
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT COMBO 36+3/33
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT COMBO 36+6/33
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL INSRT COMBO 36+6/33
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
HUMERAL SPACER 36*12MM
|
Facility
|
IP
|
$3,915.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.95 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.65
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
