|
HUMERAL ASSEMBLY LRG R LG STEM
|
Facility
|
IP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY LRG RT 89MM
|
Facility
|
IP
|
$21,272.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,381.60 |
| Max. Negotiated Rate |
$20,421.12 |
| Rate for Payer: Aetna Commercial |
$16,379.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,592.16
|
| Rate for Payer: Cash Price |
$10,636.00
|
| Rate for Payer: Cigna Commercial |
$17,655.76
|
| Rate for Payer: First Health Commercial |
$20,208.40
|
| Rate for Payer: Humana Commercial |
$18,081.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,443.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,698.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,719.36
|
| Rate for Payer: Ohio Health Group HMO |
$15,954.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,017.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,506.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,677.68
|
| Rate for Payer: PHCS Commercial |
$20,421.12
|
| Rate for Payer: United Healthcare All Payer |
$18,719.36
|
|
|
HUMERAL ASSEMBLY LRG RT 89MM
|
Facility
|
OP
|
$21,272.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,381.60 |
| Max. Negotiated Rate |
$20,421.12 |
| Rate for Payer: Aetna Commercial |
$16,379.44
|
| Rate for Payer: Anthem Medicaid |
$7,315.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,592.16
|
| Rate for Payer: Cash Price |
$10,636.00
|
| Rate for Payer: Cigna Commercial |
$17,655.76
|
| Rate for Payer: First Health Commercial |
$20,208.40
|
| Rate for Payer: Humana Commercial |
$18,081.20
|
| Rate for Payer: Humana KY Medicaid |
$7,315.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,389.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,443.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,698.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,462.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,719.36
|
| Rate for Payer: Ohio Health Group HMO |
$15,954.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,017.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,506.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,677.68
|
| Rate for Payer: PHCS Commercial |
$20,421.12
|
| Rate for Payer: United Healthcare All Payer |
$18,719.36
|
|
|
HUMERAL ASSEMBLY STD LEFT
|
Facility
|
IP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD LEFT
|
Facility
|
OP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem Medicaid |
$5,846.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Humana KY Medicaid |
$5,846.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,906.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD L LG STEM
|
Facility
|
OP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem Medicaid |
$5,846.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Humana KY Medicaid |
$5,846.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,906.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD L LG STEM
|
Facility
|
IP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD RIGHT
|
Facility
|
IP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD RIGHT
|
Facility
|
OP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem Medicaid |
$5,846.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Humana KY Medicaid |
$5,846.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,906.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD R LG STEM
|
Facility
|
IP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSEMBLY STD R LG STEM
|
Facility
|
OP
|
$17,000.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,100.22 |
| Max. Negotiated Rate |
$16,320.69 |
| Rate for Payer: Aetna Commercial |
$13,090.55
|
| Rate for Payer: Anthem Medicaid |
$5,846.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,260.56
|
| Rate for Payer: Cash Price |
$8,500.36
|
| Rate for Payer: Cigna Commercial |
$14,110.60
|
| Rate for Payer: First Health Commercial |
$16,150.68
|
| Rate for Payer: Humana Commercial |
$14,450.61
|
| Rate for Payer: Humana KY Medicaid |
$5,846.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,906.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,940.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,546.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,100.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,963.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,960.63
|
| Rate for Payer: Ohio Health Group HMO |
$12,750.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,600.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,790.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,730.50
|
| Rate for Payer: PHCS Commercial |
$16,320.69
|
| Rate for Payer: United Healthcare All Payer |
$14,960.63
|
|
|
HUMERAL ASSY TOT ELBOW SM 4
|
Facility
|
IP
|
$25,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,575.00 |
| Max. Negotiated Rate |
$24,240.00 |
| Rate for Payer: Aetna Commercial |
$19,442.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,695.00
|
| Rate for Payer: Cash Price |
$12,625.00
|
| Rate for Payer: Cigna Commercial |
$20,957.50
|
| Rate for Payer: First Health Commercial |
$23,987.50
|
| Rate for Payer: Humana Commercial |
$21,462.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,705.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,634.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,575.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,220.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,967.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,422.50
|
| Rate for Payer: PHCS Commercial |
$24,240.00
|
| Rate for Payer: United Healthcare All Payer |
$22,220.00
|
|
|
HUMERAL ASSY TOT ELBOW SM 4
|
Facility
|
OP
|
$25,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,575.00 |
| Max. Negotiated Rate |
$24,240.00 |
| Rate for Payer: Aetna Commercial |
$19,442.50
|
| Rate for Payer: Anthem Medicaid |
$8,683.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,695.00
|
| Rate for Payer: Cash Price |
$12,625.00
|
| Rate for Payer: Cigna Commercial |
$20,957.50
|
| Rate for Payer: First Health Commercial |
$23,987.50
|
| Rate for Payer: Humana Commercial |
$21,462.50
|
| Rate for Payer: Humana KY Medicaid |
$8,683.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,771.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,705.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,634.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,575.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,857.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,220.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,967.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,422.50
|
| Rate for Payer: PHCS Commercial |
$24,240.00
|
| Rate for Payer: United Healthcare All Payer |
$22,220.00
|
|
|
HUMERAL BEARNG/BUSHING KIT LRG
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
HUMERAL BEARNG/BUSHING KIT LRG
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
HUMERAL BEARNG/BUSHING KIT STD
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.90 |
| Max. Negotiated Rate |
$4,399.68 |
| Rate for Payer: Aetna Commercial |
$3,528.91
|
| Rate for Payer: Anthem Medicaid |
$1,576.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,574.74
|
| Rate for Payer: Cash Price |
$2,291.50
|
| Rate for Payer: Cigna Commercial |
$3,803.89
|
| Rate for Payer: First Health Commercial |
$4,353.85
|
| Rate for Payer: Humana Commercial |
$3,895.55
|
| Rate for Payer: Humana KY Medicaid |
$1,576.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,592.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,758.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,607.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,033.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,437.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,987.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.27
|
| Rate for Payer: PHCS Commercial |
$4,399.68
|
| Rate for Payer: United Healthcare All Payer |
$4,033.04
|
|
|
HUMERAL BEARNG/BUSHING KIT STD
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.90 |
| Max. Negotiated Rate |
$4,399.68 |
| Rate for Payer: Aetna Commercial |
$3,528.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,574.74
|
| Rate for Payer: Cash Price |
$2,291.50
|
| Rate for Payer: Cigna Commercial |
$3,803.89
|
| Rate for Payer: First Health Commercial |
$4,353.85
|
| Rate for Payer: Humana Commercial |
$3,895.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,758.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,033.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,437.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,987.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.27
|
| Rate for Payer: PHCS Commercial |
$4,399.68
|
| Rate for Payer: United Healthcare All Payer |
$4,033.04
|
|
|
HUMERAL CEM DIAPHYSIS SZ 0 L85
|
Facility
|
IP
|
$23,913.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,174.05 |
| Max. Negotiated Rate |
$22,956.96 |
| Rate for Payer: Aetna Commercial |
$18,413.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,652.53
|
| Rate for Payer: Cash Price |
$11,956.75
|
| Rate for Payer: Cigna Commercial |
$19,848.21
|
| Rate for Payer: First Health Commercial |
$22,717.83
|
| Rate for Payer: Humana Commercial |
$20,326.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,609.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,648.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,174.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,043.88
|
| Rate for Payer: Ohio Health Group HMO |
$17,935.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,130.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,804.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,500.31
|
| Rate for Payer: PHCS Commercial |
$22,956.96
|
| Rate for Payer: United Healthcare All Payer |
$21,043.88
|
|
|
HUMERAL CEM DIAPHYSIS SZ 0 L85
|
Facility
|
OP
|
$23,913.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,174.05 |
| Max. Negotiated Rate |
$22,956.96 |
| Rate for Payer: Aetna Commercial |
$18,413.40
|
| Rate for Payer: Anthem Medicaid |
$8,223.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,652.53
|
| Rate for Payer: Cash Price |
$11,956.75
|
| Rate for Payer: Cigna Commercial |
$19,848.21
|
| Rate for Payer: First Health Commercial |
$22,717.83
|
| Rate for Payer: Humana Commercial |
$20,326.47
|
| Rate for Payer: Humana KY Medicaid |
$8,223.85
|
| Rate for Payer: Kentucky WC Medicaid |
$8,307.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,609.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,648.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,174.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,388.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,043.88
|
| Rate for Payer: Ohio Health Group HMO |
$17,935.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,130.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,804.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,500.31
|
| Rate for Payer: PHCS Commercial |
$22,956.96
|
| Rate for Payer: United Healthcare All Payer |
$21,043.88
|
|
|
HUMERAL CEM DIAPHYSIS SZ 1 L86
|
Facility
|
OP
|
$8,440.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,532.10 |
| Max. Negotiated Rate |
$8,102.72 |
| Rate for Payer: Aetna Commercial |
$6,499.05
|
| Rate for Payer: Anthem Medicaid |
$2,902.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,583.46
|
| Rate for Payer: Cash Price |
$4,220.16
|
| Rate for Payer: Cigna Commercial |
$7,005.47
|
| Rate for Payer: First Health Commercial |
$8,018.31
|
| Rate for Payer: Humana Commercial |
$7,174.28
|
| Rate for Payer: Humana KY Medicaid |
$2,902.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,932.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,921.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,532.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,960.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,427.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,752.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,343.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.83
|
| Rate for Payer: PHCS Commercial |
$8,102.72
|
| Rate for Payer: United Healthcare All Payer |
$7,427.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 1 L86
|
Facility
|
IP
|
$8,440.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,532.10 |
| Max. Negotiated Rate |
$8,102.72 |
| Rate for Payer: Aetna Commercial |
$6,499.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,583.46
|
| Rate for Payer: Cash Price |
$4,220.16
|
| Rate for Payer: Cigna Commercial |
$7,005.47
|
| Rate for Payer: First Health Commercial |
$8,018.31
|
| Rate for Payer: Humana Commercial |
$7,174.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,921.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,532.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,427.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,752.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,343.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.83
|
| Rate for Payer: PHCS Commercial |
$8,102.72
|
| Rate for Payer: United Healthcare All Payer |
$7,427.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 2 L88
|
Facility
|
OP
|
$8,440.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,532.10 |
| Max. Negotiated Rate |
$8,102.72 |
| Rate for Payer: Aetna Commercial |
$6,499.05
|
| Rate for Payer: Anthem Medicaid |
$2,902.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,583.46
|
| Rate for Payer: Cash Price |
$4,220.16
|
| Rate for Payer: Cigna Commercial |
$7,005.47
|
| Rate for Payer: First Health Commercial |
$8,018.31
|
| Rate for Payer: Humana Commercial |
$7,174.28
|
| Rate for Payer: Humana KY Medicaid |
$2,902.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,932.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,921.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,532.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,960.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,427.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,752.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,343.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.83
|
| Rate for Payer: PHCS Commercial |
$8,102.72
|
| Rate for Payer: United Healthcare All Payer |
$7,427.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 2 L88
|
Facility
|
IP
|
$8,440.33
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,532.10 |
| Max. Negotiated Rate |
$8,102.72 |
| Rate for Payer: Aetna Commercial |
$6,499.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,583.46
|
| Rate for Payer: Cash Price |
$4,220.16
|
| Rate for Payer: Cigna Commercial |
$7,005.47
|
| Rate for Payer: First Health Commercial |
$8,018.31
|
| Rate for Payer: Humana Commercial |
$7,174.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,921.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,228.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,532.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,427.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,752.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,343.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,823.83
|
| Rate for Payer: PHCS Commercial |
$8,102.72
|
| Rate for Payer: United Healthcare All Payer |
$7,427.49
|
|
|
HUMERAL CEM DIAPHYSIS SZ 3 L89
|
Facility
|
OP
|
$22,156.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,647.07 |
| Max. Negotiated Rate |
$21,270.61 |
| Rate for Payer: Aetna Commercial |
$17,060.81
|
| Rate for Payer: Anthem Medicaid |
$7,619.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,282.37
|
| Rate for Payer: Cash Price |
$11,078.44
|
| Rate for Payer: Cigna Commercial |
$18,390.22
|
| Rate for Payer: First Health Commercial |
$21,049.05
|
| Rate for Payer: Humana Commercial |
$18,833.36
|
| Rate for Payer: Humana KY Medicaid |
$7,619.75
|
| Rate for Payer: Kentucky WC Medicaid |
$7,697.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,168.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,351.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,647.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,772.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,498.06
|
| Rate for Payer: Ohio Health Group HMO |
$16,617.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,725.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,276.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,288.25
|
| Rate for Payer: PHCS Commercial |
$21,270.61
|
| Rate for Payer: United Healthcare All Payer |
$19,498.06
|
|
|
HUMERAL CEM DIAPHYSIS SZ 3 L89
|
Facility
|
IP
|
$22,156.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,647.07 |
| Max. Negotiated Rate |
$21,270.61 |
| Rate for Payer: Aetna Commercial |
$17,060.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,282.37
|
| Rate for Payer: Cash Price |
$11,078.44
|
| Rate for Payer: Cigna Commercial |
$18,390.22
|
| Rate for Payer: First Health Commercial |
$21,049.05
|
| Rate for Payer: Humana Commercial |
$18,833.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,168.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,351.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,647.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,498.06
|
| Rate for Payer: Ohio Health Group HMO |
$16,617.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,725.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,276.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,288.25
|
| Rate for Payer: PHCS Commercial |
$21,270.61
|
| Rate for Payer: United Healthcare All Payer |
$19,498.06
|
|
