|
LINER G7 NEUTRAL E1 44MM J
|
Facility
|
IP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER HUMERAL L/42+3
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL L/42+3
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL L/42+3 CONST
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER HUMERAL L/42+3 CONST
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER HUMERAL L/42+6
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL L/42+6
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL L/42+6 CONST
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL L/42+6 CONST
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+3
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+3
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+3 CONST
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+3 CONST
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+6
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+6
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+6 CONST
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL M/39+6 CONST
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+3
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+3
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+3 CONST
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+3 CONST
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+6
|
Facility
|
OP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem Medicaid |
$2,236.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Humana KY Medicaid |
$2,236.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,259.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,281.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+6
|
Facility
|
IP
|
$6,504.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.62 |
| Max. Negotiated Rate |
$6,244.56 |
| Rate for Payer: Aetna Commercial |
$5,008.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,073.70
|
| Rate for Payer: Cash Price |
$3,252.38
|
| Rate for Payer: Cigna Commercial |
$5,398.94
|
| Rate for Payer: First Health Commercial |
$6,179.51
|
| Rate for Payer: Humana Commercial |
$5,529.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,333.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,800.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,878.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.47
|
| Rate for Payer: PHCS Commercial |
$6,244.56
|
| Rate for Payer: United Healthcare All Payer |
$5,724.18
|
|
|
LINER HUMERAL S/36+6 CONST
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER HUMERAL S/36+6 CONST
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
