|
HUMERAL HD. 36MMX52MM
|
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 36MMX56MM
|
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 36MMX56MM
|
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 39MMX56MM
|
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 39MMX56MM
|
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. 42MMX56MM
|
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. 42MMX56MM
|
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 HEAD 40MM*17MM
|
Facility
|
IP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
HUMERAL HEAD 40MM*17MM
|
Facility
|
OP
|
$9,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,816.25 |
| Max. Negotiated Rate |
$9,012.00 |
| Rate for Payer: Aetna Commercial |
$7,228.38
|
| Rate for Payer: Anthem Medicaid |
$3,228.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.25
|
| Rate for Payer: Cash Price |
$4,693.75
|
| Rate for Payer: Cigna Commercial |
$7,791.62
|
| Rate for Payer: First Health Commercial |
$8,918.12
|
| Rate for Payer: Humana Commercial |
$7,979.38
|
| Rate for Payer: Humana KY Medicaid |
$3,228.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,697.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,927.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,167.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,477.38
|
| Rate for Payer: PHCS Commercial |
$9,012.00
|
| Rate for Payer: United Healthcare All Payer |
$8,261.00
|
|
|
HUMERAL HEAD SOLAR 50MM*18MM
|
Facility
|
IP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
HUMERAL HEAD SOLAR 50MM*18MM
|
Facility
|
OP
|
$8,074.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,422.49 |
| Max. Negotiated Rate |
$7,751.96 |
| Rate for Payer: Aetna Commercial |
$6,217.72
|
| Rate for Payer: Anthem Medicaid |
$2,776.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,298.47
|
| Rate for Payer: Cash Price |
$4,037.48
|
| Rate for Payer: Cigna Commercial |
$6,702.22
|
| Rate for Payer: First Health Commercial |
$7,671.21
|
| Rate for Payer: Humana Commercial |
$6,863.72
|
| Rate for Payer: Humana KY Medicaid |
$2,776.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,805.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,621.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,959.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,422.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,832.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,105.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,056.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,459.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,025.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,571.72
|
| Rate for Payer: PHCS Commercial |
$7,751.96
|
| Rate for Payer: United Healthcare All Payer |
$7,105.96
|
|
|
HUMERAL INSERT 33 6
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSERT 33 6
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSERT X3 4MM 36MM
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HUMERAL INSERT X3 4MM 36MM
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HUMERAL INSRT 33+3/36
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT 33+3/36
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT 33+6/36
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT 33+6/36
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT CBO CONST36+3/33
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT CBO CONST36+3/33
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT CBO CONST36+3/39
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT CBO CONST36+3/39
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT CBO CONST36+6/33
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
HUMERAL INSRT CBO CONST36+6/33
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
