|
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
|
|
|
HUMERAL SPACER 36*15MM
|
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
|
|
|
HUMERAL SPACER 36*15MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 36*6MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 36*6MM
|
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
|
|
|
HUMERAL SPACER 36*9MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 36*9MM
|
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
|
|
|
HUMERAL SPACER 39*12MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 39*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
|
|
|
HUMERAL SPACER 39*15MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 39*15MM
|
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
|
|
|
HUMERAL SPACER 39*6MM
|
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
|
|
|
HUMERAL SPACER 39*6MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 39*9MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 39*9MM
|
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
|
|
|
HUMERAL SPACER 42*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
|
|
|
HUMERAL SPACER 42*12MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 42*15MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 42*15MM
|
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
|
|
|
HUMERAL SPACER 42*6MM
|
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
|
|
|
HUMERAL SPACER 42*6MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 42*9MM
|
Facility
|
OP
|
$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 Medicaid |
$1,346.37
|
| 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: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| 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: Molina Healthcare Medicaid |
$1,373.38
|
| 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
|
|
|
HUMERAL SPACER 42*9MM
|
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
|
|
|
HUMERAL SPACER DIA 36+ 9MM
|
Facility
|
OP
|
$4,195.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.35 |
| Max. Negotiated Rate |
$4,027.20 |
| Rate for Payer: Aetna Commercial |
$3,230.15
|
| Rate for Payer: Anthem Medicaid |
$1,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.10
|
| Rate for Payer: Cash Price |
$2,097.50
|
| Rate for Payer: Cigna Commercial |
$3,481.85
|
| Rate for Payer: First Health Commercial |
$3,985.25
|
| Rate for Payer: Humana Commercial |
$3,565.75
|
| Rate for Payer: Humana KY Medicaid |
$1,442.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,439.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,095.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$839.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$545.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.45
|
| Rate for Payer: PHCS Commercial |
$4,027.20
|
| Rate for Payer: United Healthcare All Payer |
$3,691.60
|
|
|
HUMERAL SPACER DIA 36+ 9MM
|
Facility
|
IP
|
$4,195.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$545.35 |
| Max. Negotiated Rate |
$4,027.20 |
| Rate for Payer: Aetna Commercial |
$3,230.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.10
|
| Rate for Payer: Cash Price |
$2,097.50
|
| Rate for Payer: Cigna Commercial |
$3,481.85
|
| Rate for Payer: First Health Commercial |
$3,985.25
|
| Rate for Payer: Humana Commercial |
$3,565.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,439.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,095.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,691.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$839.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$545.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.45
|
| Rate for Payer: PHCS Commercial |
$4,027.20
|
| Rate for Payer: United Healthcare All Payer |
$3,691.60
|
|
