|
HUMERAL SPACER 42*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 42*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 42*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 DIA 36+ 9MM
|
Facility
|
OP
|
$4,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.25 |
| Max. Negotiated Rate |
$3,972.00 |
| Rate for Payer: Aetna Commercial |
$3,185.88
|
| Rate for Payer: Anthem Medicaid |
$1,422.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.25
|
| Rate for Payer: Cash Price |
$2,068.75
|
| Rate for Payer: Cigna Commercial |
$3,434.12
|
| Rate for Payer: First Health Commercial |
$3,930.62
|
| Rate for Payer: Humana Commercial |
$3,516.88
|
| Rate for Payer: Humana KY Medicaid |
$1,422.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.88
|
| Rate for Payer: PHCS Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Payer |
$3,641.00
|
|
|
HUMERAL SPACER DIA 36+ 9MM
|
Facility
|
IP
|
$4,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.25 |
| Max. Negotiated Rate |
$3,972.00 |
| Rate for Payer: Aetna Commercial |
$3,185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,227.25
|
| Rate for Payer: Cash Price |
$2,068.75
|
| Rate for Payer: Cigna Commercial |
$3,434.12
|
| Rate for Payer: First Health Commercial |
$3,930.62
|
| Rate for Payer: Humana Commercial |
$3,516.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,641.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,103.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.88
|
| Rate for Payer: PHCS Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Payer |
$3,641.00
|
|
|
HUMERAL SPACER DIA 42+ 9MM
|
Facility
|
IP
|
$4,351.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,305.38 |
| Max. Negotiated Rate |
$4,177.20 |
| Rate for Payer: Aetna Commercial |
$3,350.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.97
|
| Rate for Payer: Cash Price |
$2,175.62
|
| Rate for Payer: Cigna Commercial |
$3,611.54
|
| Rate for Payer: First Health Commercial |
$4,133.69
|
| Rate for Payer: Humana Commercial |
$3,698.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,785.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.36
|
| Rate for Payer: PHCS Commercial |
$4,177.20
|
| Rate for Payer: United Healthcare All Payer |
$3,829.10
|
|
|
HUMERAL SPACER DIA 42+ 9MM
|
Facility
|
OP
|
$4,351.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,305.38 |
| Max. Negotiated Rate |
$4,177.20 |
| Rate for Payer: Aetna Commercial |
$3,350.46
|
| Rate for Payer: Anthem Medicaid |
$1,496.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.97
|
| Rate for Payer: Cash Price |
$2,175.62
|
| Rate for Payer: Cigna Commercial |
$3,611.54
|
| Rate for Payer: First Health Commercial |
$4,133.69
|
| Rate for Payer: Humana Commercial |
$3,698.56
|
| Rate for Payer: Humana KY Medicaid |
$1,496.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,481.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,785.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.36
|
| Rate for Payer: PHCS Commercial |
$4,177.20
|
| Rate for Payer: United Healthcare All Payer |
$3,829.10
|
|
|
HUMERAL STEM 10MM
|
Facility
|
OP
|
$31,227.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,368.25 |
| Max. Negotiated Rate |
$29,978.40 |
| Rate for Payer: Aetna Commercial |
$24,045.17
|
| Rate for Payer: Anthem Medicaid |
$10,739.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,357.45
|
| Rate for Payer: Cash Price |
$15,613.75
|
| Rate for Payer: Cigna Commercial |
$25,918.83
|
| Rate for Payer: First Health Commercial |
$29,666.12
|
| Rate for Payer: Humana Commercial |
$26,543.38
|
| Rate for Payer: Humana KY Medicaid |
$10,739.14
|
| Rate for Payer: Kentucky WC Medicaid |
$10,848.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,606.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,045.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,368.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,954.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,480.20
|
| Rate for Payer: Ohio Health Group HMO |
$23,420.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,982.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,167.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,546.97
|
| Rate for Payer: PHCS Commercial |
$29,978.40
|
| Rate for Payer: United Healthcare All Payer |
$27,480.20
|
|
|
HUMERAL STEM 10MM
|
Facility
|
IP
|
$31,227.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,368.25 |
| Max. Negotiated Rate |
$29,978.40 |
| Rate for Payer: Aetna Commercial |
$24,045.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,357.45
|
| Rate for Payer: Cash Price |
$15,613.75
|
| Rate for Payer: Cigna Commercial |
$25,918.83
|
| Rate for Payer: First Health Commercial |
$29,666.12
|
| Rate for Payer: Humana Commercial |
$26,543.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,606.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,045.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,368.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,480.20
|
| Rate for Payer: Ohio Health Group HMO |
$23,420.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,982.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,167.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,546.97
|
| Rate for Payer: PHCS Commercial |
$29,978.40
|
| Rate for Payer: United Healthcare All Payer |
$27,480.20
|
|
|
HUMERAL STEM REV 10MM*108MM
|
Facility
|
IP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 10MM*108MM
|
Facility
|
OP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem Medicaid |
$11,073.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Humana KY Medicaid |
$11,073.15
|
| Rate for Payer: Kentucky WC Medicaid |
$11,185.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,295.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 12MM*108MM
|
Facility
|
IP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 12MM*108MM
|
Facility
|
OP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem Medicaid |
$11,073.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Humana KY Medicaid |
$11,073.15
|
| Rate for Payer: Kentucky WC Medicaid |
$11,185.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,295.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 14MM*108MM
|
Facility
|
IP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 14MM*108MM
|
Facility
|
OP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem Medicaid |
$11,073.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Humana KY Medicaid |
$11,073.15
|
| Rate for Payer: Kentucky WC Medicaid |
$11,185.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,295.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 8MM*108MM
|
Facility
|
IP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERAL STEM REV 8MM*108MM
|
Facility
|
OP
|
$32,198.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,659.62 |
| Max. Negotiated Rate |
$30,910.80 |
| Rate for Payer: Aetna Commercial |
$24,793.04
|
| Rate for Payer: Anthem Medicaid |
$11,073.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,115.03
|
| Rate for Payer: Cash Price |
$16,099.38
|
| Rate for Payer: Cigna Commercial |
$26,724.96
|
| Rate for Payer: First Health Commercial |
$30,588.81
|
| Rate for Payer: Humana Commercial |
$27,368.94
|
| Rate for Payer: Humana KY Medicaid |
$11,073.15
|
| Rate for Payer: Kentucky WC Medicaid |
$11,185.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,402.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,762.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,659.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,295.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,334.90
|
| Rate for Payer: Ohio Health Group HMO |
$24,149.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,759.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,012.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,217.14
|
| Rate for Payer: PHCS Commercial |
$30,910.80
|
| Rate for Payer: United Healthcare All Payer |
$28,334.90
|
|
|
HUMERUS MIN OF 2V
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
HUMERUS MIN OF 2V
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$258.60 |
| Rate for Payer: Aetna Commercial |
$44.41
|
| Rate for Payer: Ambetter Exchange |
$28.83
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.60
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$41.61
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$258.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$150.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.83
|
|
|
HUMERUS MIN OF 2V
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
32000078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem Medicaid |
$148.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Humana KY Medicaid |
$148.22
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$149.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
HUMERUS MIN OF 2V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
320P0078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$45.33 |
| Rate for Payer: Aetna Commercial |
$44.41
|
| Rate for Payer: Ambetter Exchange |
$28.83
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.60
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$45.33
|
| Rate for Payer: Healthspan PPO |
$41.61
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.83
|
|
|
HUMERUS MIN OF 2V(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
320T0078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
HUMERUS MIN OF 2V(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 73060
|
| Hospital Charge Code |
320T0078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
HUMIBID (COMBINATION) DM 1TAB
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 63824005634
|
| Hospital Charge Code |
25000753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
HUMIBID (COMBINATION) DM 1TAB
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 63824005634
|
| Hospital Charge Code |
25000753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
