|
HUMERAL INSRT COMBO 36+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 COMBO 36+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 COMBO 36+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
|
|
|
HUMERAL INSRT COMBO 36+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 SPACER 36*12MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*12MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*15MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*15MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*6MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*6MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*9MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 36*9MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*12MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*12MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*15MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*15MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*6MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*6MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*9MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 39*9MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 42*12MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 42*12MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 42*15MM
|
Facility
|
OP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem Medicaid |
$1,319.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Humana KY Medicaid |
$1,319.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 42*15MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
|
HUMERAL SPACER 42*6MM
|
Facility
|
IP
|
$3,837.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.25 |
| Max. Negotiated Rate |
$3,684.00 |
| Rate for Payer: Aetna Commercial |
$2,954.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.25
|
| Rate for Payer: Cash Price |
$1,918.75
|
| Rate for Payer: Cigna Commercial |
$3,185.12
|
| Rate for Payer: First Health Commercial |
$3,645.62
|
| Rate for Payer: Humana Commercial |
$3,261.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,832.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,377.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,878.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.88
|
| Rate for Payer: PHCS Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Payer |
$3,377.00
|
|
