|
HUMERAL COMP 54MM*50MM 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 54MM*50MM 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 54MM*50MM 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 56MM*52MM 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 56MM*52MM 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 56MM*52MM 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 56MM*52MM 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 58MM*54MM 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 58MM*54MM 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 58MM*54MM 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 58MM*54MM 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 HD 15MMX40MM
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
HUMERAL HD 15MMX40MM
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
HUMERAL HD 15MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 15MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 18MMX40MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 18MMX40MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 18MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 18MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 18MMX52MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 18MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 21MMX40MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 21MMX40MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 21MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 21MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
