|
HUMERAL SPACER DIA 42+ 9MM
|
Facility
|
OP
|
$4,394.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.28 |
| Max. Negotiated Rate |
$4,218.72 |
| Rate for Payer: Aetna Commercial |
$3,383.76
|
| Rate for Payer: Anthem Medicaid |
$1,511.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,427.71
|
| Rate for Payer: Cash Price |
$2,197.25
|
| Rate for Payer: Cigna Commercial |
$3,647.44
|
| Rate for Payer: First Health Commercial |
$4,174.78
|
| Rate for Payer: Humana Commercial |
$3,735.32
|
| Rate for Payer: Humana KY Medicaid |
$1,511.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,526.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,603.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,243.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,318.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,541.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,867.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,295.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,362.30
|
| Rate for Payer: PHCS Commercial |
$4,218.72
|
| Rate for Payer: United Healthcare All Payer |
$3,867.16
|
|
|
HUMERAL SPACER DIA 42+ 9MM
|
Facility
|
IP
|
$4,394.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.28 |
| Max. Negotiated Rate |
$4,218.72 |
| Rate for Payer: Aetna Commercial |
$3,383.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,427.71
|
| Rate for Payer: Cash Price |
$2,197.25
|
| Rate for Payer: Cigna Commercial |
$3,647.44
|
| Rate for Payer: First Health Commercial |
$4,174.78
|
| Rate for Payer: Humana Commercial |
$3,735.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,603.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,243.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,318.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,867.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,295.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,362.30
|
| Rate for Payer: PHCS Commercial |
$4,218.72
|
| Rate for Payer: United Healthcare All Payer |
$3,867.16
|
|
|
HUMERAL STEM 10MM
|
Facility
|
OP
|
$30,328.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,942.65 |
| Max. Negotiated Rate |
$29,114.98 |
| Rate for Payer: Aetna Commercial |
$23,352.64
|
| Rate for Payer: Anthem Medicaid |
$10,429.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,655.92
|
| Rate for Payer: Cash Price |
$15,164.05
|
| Rate for Payer: Cigna Commercial |
$25,172.32
|
| Rate for Payer: First Health Commercial |
$28,811.70
|
| Rate for Payer: Humana Commercial |
$25,778.88
|
| Rate for Payer: Humana KY Medicaid |
$10,429.83
|
| Rate for Payer: Kentucky WC Medicaid |
$10,535.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,869.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,382.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,098.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,639.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,688.73
|
| Rate for Payer: Ohio Health Group HMO |
$22,746.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,065.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,401.71
|
| Rate for Payer: PHCS Commercial |
$29,114.98
|
| Rate for Payer: United Healthcare All Payer |
$26,688.73
|
|
|
HUMERAL STEM 10MM
|
Facility
|
IP
|
$30,328.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,942.65 |
| Max. Negotiated Rate |
$29,114.98 |
| Rate for Payer: Aetna Commercial |
$23,352.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,655.92
|
| Rate for Payer: Cash Price |
$15,164.05
|
| Rate for Payer: Cigna Commercial |
$25,172.32
|
| Rate for Payer: First Health Commercial |
$28,811.70
|
| Rate for Payer: Humana Commercial |
$25,778.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,869.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,382.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,098.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,688.73
|
| Rate for Payer: Ohio Health Group HMO |
$22,746.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,065.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,401.71
|
| Rate for Payer: PHCS Commercial |
$29,114.98
|
| Rate for Payer: United Healthcare All Payer |
$26,688.73
|
|
|
HUMERAL STEM REV 10MM*108MM
|
Facility
|
IP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 10MM*108MM
|
Facility
|
OP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem Medicaid |
$10,754.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Humana KY Medicaid |
$10,754.94
|
| Rate for Payer: Kentucky WC Medicaid |
$10,864.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,970.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 12MM*108MM
|
Facility
|
IP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 12MM*108MM
|
Facility
|
OP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem Medicaid |
$10,754.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Humana KY Medicaid |
$10,754.94
|
| Rate for Payer: Kentucky WC Medicaid |
$10,864.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,970.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 14MM*108MM
|
Facility
|
OP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem Medicaid |
$10,754.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Humana KY Medicaid |
$10,754.94
|
| Rate for Payer: Kentucky WC Medicaid |
$10,864.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,970.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 14MM*108MM
|
Facility
|
IP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 8MM*108MM
|
Facility
|
IP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERAL STEM REV 8MM*108MM
|
Facility
|
OP
|
$31,273.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,065.55 |
| Max. Negotiated Rate |
$30,022.51 |
| Rate for Payer: Aetna Commercial |
$24,080.56
|
| Rate for Payer: Anthem Medicaid |
$10,754.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,393.29
|
| Rate for Payer: Cash Price |
$15,636.73
|
| Rate for Payer: Cigna Commercial |
$25,956.96
|
| Rate for Payer: First Health Commercial |
$29,709.78
|
| Rate for Payer: Humana Commercial |
$26,582.43
|
| Rate for Payer: Humana KY Medicaid |
$10,754.94
|
| Rate for Payer: Kentucky WC Medicaid |
$10,864.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,644.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,079.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,382.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,970.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$23,455.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,065.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,694.77
|
| Rate for Payer: PHCS Commercial |
$30,022.51
|
| Rate for Payer: United Healthcare All Payer |
$27,520.64
|
|
|
HUMERUS MIN OF 2V
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem Medicaid |
$139.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Humana KY Medicaid |
$139.97
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$141.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.17
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
HUMERUS MIN OF 2V
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Aetna Commercial |
$44.41
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$407.00
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$41.61
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$244.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$284.90
|
| Rate for Payer: UHCCP Medicaid |
$142.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
|
|
HUMERUS MIN OF 2V
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$390.72 |
| Rate for Payer: Aetna Commercial |
$313.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$317.46
|
| Rate for Payer: Cash Price |
$203.50
|
| Rate for Payer: Cigna Commercial |
$337.81
|
| Rate for Payer: First Health Commercial |
$386.65
|
| Rate for Payer: Humana Commercial |
$345.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$333.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$300.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$358.16
|
| Rate for Payer: Ohio Health Group HMO |
$305.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.17
|
| Rate for Payer: PHCS Commercial |
$390.72
|
| Rate for Payer: United Healthcare All Payer |
$358.16
|
|
|
HUMERUS MIN OF 2V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
320P0078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$45.33 |
| Rate for Payer: Aetna Commercial |
$44.41
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$41.61
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
|
|
HUMERUS MIN OF 2V(T
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
320T0078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem Medicaid |
$126.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Humana KY Medicaid |
$126.21
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
HUMERUS MIN OF 2V(T
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
320T0078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$352.32 |
| Rate for Payer: Aetna Commercial |
$282.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$286.26
|
| Rate for Payer: Cash Price |
$183.50
|
| Rate for Payer: Cigna Commercial |
$304.61
|
| Rate for Payer: First Health Commercial |
$348.65
|
| Rate for Payer: Humana Commercial |
$311.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$300.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$270.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$322.96
|
| Rate for Payer: Ohio Health Group HMO |
$275.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.77
|
| Rate for Payer: PHCS Commercial |
$352.32
|
| Rate for Payer: United Healthcare All Payer |
$322.96
|
|
|
HUMIBID (COMBINATION) DM 1TAB
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 63824005634
|
| Hospital Charge Code |
25000753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
HUMIBID (COMBINATION) DM 1TAB
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 63824005634
|
| Hospital Charge Code |
25000753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
HUMIRA 40MG/0.8ML KIT
|
Facility
|
IP
|
$18,864.14
|
|
|
Service Code
|
HCPCS J0135
|
| Hospital Charge Code |
25001825
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,452.34 |
| Max. Negotiated Rate |
$18,109.57 |
| Rate for Payer: Aetna Commercial |
$14,525.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,714.03
|
| Rate for Payer: Cash Price |
$9,432.07
|
| Rate for Payer: Cigna Commercial |
$15,657.24
|
| Rate for Payer: First Health Commercial |
$17,920.93
|
| Rate for Payer: Humana Commercial |
$16,034.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,468.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,921.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,659.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,600.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,148.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,452.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.88
|
| Rate for Payer: PHCS Commercial |
$18,109.57
|
| Rate for Payer: United Healthcare All Payer |
$16,600.44
|
|
|
HUMIRA 40MG/0.8ML KIT
|
Facility
|
OP
|
$18,864.14
|
|
|
Service Code
|
HCPCS J0135
|
| Hospital Charge Code |
25001825
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,834.49 |
| Max. Negotiated Rate |
$18,109.57 |
| Rate for Payer: Aetna Commercial |
$14,525.39
|
| Rate for Payer: Anthem Medicaid |
$6,487.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,834.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,714.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,568.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,476.57
|
| Rate for Payer: Cash Price |
$9,432.07
|
| Rate for Payer: Cash Price |
$9,432.07
|
| Rate for Payer: Cigna Commercial |
$15,657.24
|
| Rate for Payer: First Health Commercial |
$17,920.93
|
| Rate for Payer: Humana Commercial |
$16,034.52
|
| Rate for Payer: Humana KY Medicaid |
$6,487.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,834.49
|
| Rate for Payer: Kentucky WC Medicaid |
$6,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,468.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,921.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,617.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,600.44
|
| Rate for Payer: Ohio Health Group HMO |
$14,148.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,772.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,452.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.88
|
| Rate for Payer: PHCS Commercial |
$18,109.57
|
| Rate for Payer: United Healthcare All Payer |
$16,600.44
|
|
|
HUMIRA 80MG/0.8ML
|
Facility
|
IP
|
$37,728.39
|
|
|
Service Code
|
HCPCS J0135
|
| Hospital Charge Code |
25003787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,904.69 |
| Max. Negotiated Rate |
$36,219.25 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,428.14
|
| Rate for Payer: Cash Price |
$18,864.20
|
| Rate for Payer: Cigna Commercial |
$31,314.56
|
| Rate for Payer: First Health Commercial |
$35,841.97
|
| Rate for Payer: Humana Commercial |
$32,069.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,937.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,843.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,318.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,200.98
|
| Rate for Payer: Ohio Health Group HMO |
$28,296.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,545.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,695.80
|
| Rate for Payer: PHCS Commercial |
$36,219.25
|
| Rate for Payer: United Healthcare All Payer |
$33,200.98
|
| Rate for Payer: Aetna Commercial |
$29,050.86
|
|
|
HUMIRA 80MG/0.8ML
|
Facility
|
OP
|
$37,728.39
|
|
|
Service Code
|
HCPCS J0135
|
| Hospital Charge Code |
25003787
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,834.49 |
| Max. Negotiated Rate |
$36,219.25 |
| Rate for Payer: Aetna Commercial |
$29,050.86
|
| Rate for Payer: Anthem Medicaid |
$12,974.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,834.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,428.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,568.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,476.57
|
| Rate for Payer: Cash Price |
$18,864.20
|
| Rate for Payer: Cash Price |
$18,864.20
|
| Rate for Payer: Cigna Commercial |
$31,314.56
|
| Rate for Payer: First Health Commercial |
$35,841.97
|
| Rate for Payer: Humana Commercial |
$32,069.13
|
| Rate for Payer: Humana KY Medicaid |
$12,974.79
|
| Rate for Payer: Humana Medicare Advantage |
$1,834.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,106.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,937.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,843.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,235.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,200.98
|
| Rate for Payer: Ohio Health Group HMO |
$28,296.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,545.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,695.80
|
| Rate for Payer: PHCS Commercial |
$36,219.25
|
| Rate for Payer: United Healthcare All Payer |
$33,200.98
|
|
|
HUMULIN 5 UNITS [70/30 PEN]
|
Facility
|
OP
|
$72.92
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
25002173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna Commercial |
$56.15
|
| Rate for Payer: Anthem Medicaid |
$25.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.88
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cigna Commercial |
$60.52
|
| Rate for Payer: First Health Commercial |
$69.27
|
| Rate for Payer: Humana Commercial |
$61.98
|
| Rate for Payer: Humana KY Medicaid |
$25.08
|
| Rate for Payer: Kentucky WC Medicaid |
$25.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.17
|
| Rate for Payer: Ohio Health Group HMO |
$54.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.61
|
| Rate for Payer: PHCS Commercial |
$70.00
|
| Rate for Payer: United Healthcare All Payer |
$64.17
|
|
