|
HUMERAL CEM DIAPHYSIS SZ 4 L94
|
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 4 L94
|
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 EPIPHYSIS 36.1
|
Facility
|
IP
|
$13,330.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.03 |
| Max. Negotiated Rate |
$12,796.89 |
| Rate for Payer: Aetna Commercial |
$10,264.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,397.47
|
| Rate for Payer: Cash Price |
$6,665.05
|
| Rate for Payer: Cigna Commercial |
$11,063.97
|
| Rate for Payer: First Health Commercial |
$12,663.59
|
| Rate for Payer: Humana Commercial |
$11,330.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,837.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,999.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,997.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,664.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,597.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,197.76
|
| Rate for Payer: PHCS Commercial |
$12,796.89
|
| Rate for Payer: United Healthcare All Payer |
$11,730.48
|
|
|
HUMERAL CEM EPIPHYSIS 36.1
|
Facility
|
OP
|
$13,330.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.03 |
| Max. Negotiated Rate |
$12,796.89 |
| Rate for Payer: Aetna Commercial |
$10,264.17
|
| Rate for Payer: Anthem Medicaid |
$4,584.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,397.47
|
| Rate for Payer: Cash Price |
$6,665.05
|
| Rate for Payer: Cigna Commercial |
$11,063.97
|
| Rate for Payer: First Health Commercial |
$12,663.59
|
| Rate for Payer: Humana Commercial |
$11,330.58
|
| Rate for Payer: Humana KY Medicaid |
$4,584.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,630.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,837.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,999.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,676.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,997.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,664.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,597.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,197.76
|
| Rate for Payer: PHCS Commercial |
$12,796.89
|
| Rate for Payer: United Healthcare All Payer |
$11,730.48
|
|
|
HUMERAL CEM EPIPHYSIS 36.2
|
Facility
|
OP
|
$13,330.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.03 |
| Max. Negotiated Rate |
$12,796.89 |
| Rate for Payer: Aetna Commercial |
$10,264.17
|
| Rate for Payer: Anthem Medicaid |
$4,584.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,397.47
|
| Rate for Payer: Cash Price |
$6,665.05
|
| Rate for Payer: Cigna Commercial |
$11,063.97
|
| Rate for Payer: First Health Commercial |
$12,663.59
|
| Rate for Payer: Humana Commercial |
$11,330.58
|
| Rate for Payer: Humana KY Medicaid |
$4,584.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,630.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,837.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,999.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,676.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,997.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,664.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,597.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,197.76
|
| Rate for Payer: PHCS Commercial |
$12,796.89
|
| Rate for Payer: United Healthcare All Payer |
$11,730.48
|
|
|
HUMERAL CEM EPIPHYSIS 36.2
|
Facility
|
IP
|
$13,330.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.03 |
| Max. Negotiated Rate |
$12,796.89 |
| Rate for Payer: Aetna Commercial |
$10,264.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,397.47
|
| Rate for Payer: Cash Price |
$6,665.05
|
| Rate for Payer: Cigna Commercial |
$11,063.97
|
| Rate for Payer: First Health Commercial |
$12,663.59
|
| Rate for Payer: Humana Commercial |
$11,330.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,837.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,999.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,997.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,664.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,597.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,197.76
|
| Rate for Payer: PHCS Commercial |
$12,796.89
|
| Rate for Payer: United Healthcare All Payer |
$11,730.48
|
|
|
HUMERAL CEM EPIPHYSIS 42.1
|
Facility
|
OP
|
$13,330.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.03 |
| Max. Negotiated Rate |
$12,796.89 |
| Rate for Payer: Aetna Commercial |
$10,264.17
|
| Rate for Payer: Anthem Medicaid |
$4,584.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,397.47
|
| Rate for Payer: Cash Price |
$6,665.05
|
| Rate for Payer: Cigna Commercial |
$11,063.97
|
| Rate for Payer: First Health Commercial |
$12,663.59
|
| Rate for Payer: Humana Commercial |
$11,330.58
|
| Rate for Payer: Humana KY Medicaid |
$4,584.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,630.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,837.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,999.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,676.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,997.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,664.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,597.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,197.76
|
| Rate for Payer: PHCS Commercial |
$12,796.89
|
| Rate for Payer: United Healthcare All Payer |
$11,730.48
|
|
|
HUMERAL CEM EPIPHYSIS 42.1
|
Facility
|
IP
|
$13,330.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,999.03 |
| Max. Negotiated Rate |
$12,796.89 |
| Rate for Payer: Aetna Commercial |
$10,264.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,397.47
|
| Rate for Payer: Cash Price |
$6,665.05
|
| Rate for Payer: Cigna Commercial |
$11,063.97
|
| Rate for Payer: First Health Commercial |
$12,663.59
|
| Rate for Payer: Humana Commercial |
$11,330.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,837.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,999.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,730.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,997.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,664.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,597.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,197.76
|
| Rate for Payer: PHCS Commercial |
$12,796.89
|
| Rate for Payer: United Healthcare All Payer |
$11,730.48
|
|
|
HUMERAL COMP 46MM*42MM OVO
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 46MM*42MM OVO
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 46MM*42MM OVO CE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 46MM*42MM OVO CE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 48MM*44MM OVO
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 48MM*44MM OVO
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 48MM*44MM OVO CE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 48MM*44MM OVO CE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 50MM*46MM OVO
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 50MM*46MM OVO
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 50MM*46MM OVO CE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 50MM*46MM OVO CE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 52MM*48MM OVO
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 52MM*48MM OVO
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 52MM*48MM OVO CE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 52MM*48MM OVO CE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
HUMERAL COMP 54MM*50MM OVO
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
