|
AS COLS REV TIB COMP SZ 70*49M
|
Facility
|
IP
|
$28,035.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,644.67 |
| Max. Negotiated Rate |
$26,914.46 |
| Rate for Payer: Aetna Commercial |
$21,587.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,868.00
|
| Rate for Payer: Cash Price |
$14,017.95
|
| Rate for Payer: Cigna Commercial |
$23,269.80
|
| Rate for Payer: First Health Commercial |
$26,634.10
|
| Rate for Payer: Humana Commercial |
$23,830.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,989.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,690.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,410.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,671.59
|
| Rate for Payer: Ohio Health Group HMO |
$21,026.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,644.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,691.13
|
| Rate for Payer: PHCS Commercial |
$26,914.46
|
| Rate for Payer: United Healthcare All Payer |
$24,671.59
|
|
|
AS COLS REV TIB WDGE RL/LM 5MM
|
Facility
|
IP
|
$13,855.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,801.25 |
| Max. Negotiated Rate |
$13,301.57 |
| Rate for Payer: Aetna Commercial |
$10,668.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,807.52
|
| Rate for Payer: Cash Price |
$6,927.90
|
| Rate for Payer: Cigna Commercial |
$11,500.31
|
| Rate for Payer: First Health Commercial |
$13,163.01
|
| Rate for Payer: Humana Commercial |
$11,777.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,361.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,225.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,391.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,771.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,295.30
|
| Rate for Payer: PHCS Commercial |
$13,301.57
|
| Rate for Payer: United Healthcare All Payer |
$12,193.10
|
|
|
AS COLS REV TIB WDGE RL/LM 5MM
|
Facility
|
OP
|
$13,855.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,801.25 |
| Max. Negotiated Rate |
$13,301.57 |
| Rate for Payer: Aetna Commercial |
$10,668.97
|
| Rate for Payer: Anthem Medicaid |
$4,765.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,807.52
|
| Rate for Payer: Cash Price |
$6,927.90
|
| Rate for Payer: Cigna Commercial |
$11,500.31
|
| Rate for Payer: First Health Commercial |
$13,163.01
|
| Rate for Payer: Humana Commercial |
$11,777.43
|
| Rate for Payer: Humana KY Medicaid |
$4,765.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,813.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,361.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,225.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,860.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,193.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,391.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,771.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,295.30
|
| Rate for Payer: PHCS Commercial |
$13,301.57
|
| Rate for Payer: United Healthcare All Payer |
$12,193.10
|
|
|
AS COLS REV TIB WDGE RM/LL 5MM
|
Facility
|
OP
|
$13,852.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.78 |
| Max. Negotiated Rate |
$13,298.06 |
| Rate for Payer: Aetna Commercial |
$10,666.16
|
| Rate for Payer: Anthem Medicaid |
$4,763.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,804.68
|
| Rate for Payer: Cash Price |
$6,926.08
|
| Rate for Payer: Cigna Commercial |
$11,497.28
|
| Rate for Payer: First Health Commercial |
$13,159.54
|
| Rate for Payer: Humana Commercial |
$11,774.33
|
| Rate for Payer: Humana KY Medicaid |
$4,763.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,812.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,358.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,222.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,155.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,859.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,189.89
|
| Rate for Payer: Ohio Health Group HMO |
$10,389.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,294.17
|
| Rate for Payer: PHCS Commercial |
$13,298.06
|
| Rate for Payer: United Healthcare All Payer |
$12,189.89
|
|
|
AS COLS REV TIB WDGE RM/LL 5MM
|
Facility
|
IP
|
$13,852.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.78 |
| Max. Negotiated Rate |
$13,298.06 |
| Rate for Payer: Aetna Commercial |
$10,666.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,804.68
|
| Rate for Payer: Cash Price |
$6,926.08
|
| Rate for Payer: Cigna Commercial |
$11,497.28
|
| Rate for Payer: First Health Commercial |
$13,159.54
|
| Rate for Payer: Humana Commercial |
$11,774.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,358.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,222.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,155.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,189.89
|
| Rate for Payer: Ohio Health Group HMO |
$10,389.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,294.17
|
| Rate for Payer: PHCS Commercial |
$13,298.06
|
| Rate for Payer: United Healthcare All Payer |
$12,189.89
|
|
|
ASCORBID ACID (VIT 250MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
25000262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
ASCORBID ACID (VIT 250MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
25000262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
ASENDIN (AMOXAPINE) 25MG TAB
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
NDC 591571301
|
| Hospital Charge Code |
25000263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
ASENDIN (AMOXAPINE) 25MG TAB
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
NDC 591571301
|
| Hospital Charge Code |
25000263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
AS FEMUR STEM NEU 017*117 5 DE
|
Facility
|
IP
|
$20,290.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.78 |
| Max. Negotiated Rate |
$19,478.98 |
| Rate for Payer: Aetna Commercial |
$15,623.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,826.67
|
| Rate for Payer: Cash Price |
$10,145.30
|
| Rate for Payer: Cigna Commercial |
$16,841.20
|
| Rate for Payer: First Health Commercial |
$19,276.07
|
| Rate for Payer: Humana Commercial |
$17,247.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,638.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,974.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,855.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,217.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,058.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,290.09
|
| Rate for Payer: PHCS Commercial |
$19,478.98
|
| Rate for Payer: United Healthcare All Payer |
$17,855.73
|
|
|
AS FEMUR STEM NEU 017*117 5 DE
|
Facility
|
OP
|
$20,290.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.78 |
| Max. Negotiated Rate |
$19,478.98 |
| Rate for Payer: Aetna Commercial |
$15,623.76
|
| Rate for Payer: Anthem Medicaid |
$6,977.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,826.67
|
| Rate for Payer: Cash Price |
$10,145.30
|
| Rate for Payer: Cigna Commercial |
$16,841.20
|
| Rate for Payer: First Health Commercial |
$19,276.07
|
| Rate for Payer: Humana Commercial |
$17,247.01
|
| Rate for Payer: Humana KY Medicaid |
$6,977.94
|
| Rate for Payer: Kentucky WC Medicaid |
$7,048.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,638.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,974.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,117.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,855.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,217.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,058.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,290.09
|
| Rate for Payer: PHCS Commercial |
$19,478.98
|
| Rate for Payer: United Healthcare All Payer |
$17,855.73
|
|
|
AS FX HUMERAL HEAD 40 L
|
Facility
|
IP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 40 L
|
Facility
|
OP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem Medicaid |
$4,084.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Humana KY Medicaid |
$4,084.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 40 R
|
Facility
|
IP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 40 R
|
Facility
|
OP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem Medicaid |
$4,084.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Humana KY Medicaid |
$4,084.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 44 L
|
Facility
|
IP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 44 L
|
Facility
|
OP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem Medicaid |
$4,084.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Humana KY Medicaid |
$4,084.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 44 R
|
Facility
|
OP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem Medicaid |
$4,084.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Humana KY Medicaid |
$4,084.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 44 R
|
Facility
|
IP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 48 L
|
Facility
|
IP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 48 L
|
Facility
|
OP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem Medicaid |
$4,084.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Humana KY Medicaid |
$4,084.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 48 R
|
Facility
|
IP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL HEAD 48 R
|
Facility
|
OP
|
$11,876.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.89 |
| Max. Negotiated Rate |
$11,401.00 |
| Rate for Payer: Aetna Commercial |
$9,144.55
|
| Rate for Payer: Anthem Medicaid |
$4,084.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,263.31
|
| Rate for Payer: Cash Price |
$5,938.02
|
| Rate for Payer: Cigna Commercial |
$9,857.11
|
| Rate for Payer: First Health Commercial |
$11,282.24
|
| Rate for Payer: Humana Commercial |
$10,094.63
|
| Rate for Payer: Humana KY Medicaid |
$4,084.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,738.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,764.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,562.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,166.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,450.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,907.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,375.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,543.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,681.57
|
| Rate for Payer: PHCS Commercial |
$11,401.00
|
| Rate for Payer: United Healthcare All Payer |
$10,450.92
|
|
|
AS FX HUMERAL STEM 10-130
|
Facility
|
OP
|
$24,425.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,175.29 |
| Max. Negotiated Rate |
$23,448.31 |
| Rate for Payer: Aetna Commercial |
$18,807.50
|
| Rate for Payer: Anthem Medicaid |
$8,399.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,051.75
|
| Rate for Payer: Cash Price |
$12,212.66
|
| Rate for Payer: Cigna Commercial |
$20,273.02
|
| Rate for Payer: First Health Commercial |
$23,204.05
|
| Rate for Payer: Humana Commercial |
$20,761.52
|
| Rate for Payer: Humana KY Medicaid |
$8,399.87
|
| Rate for Payer: Kentucky WC Medicaid |
$8,485.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,028.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,025.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,327.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,568.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,494.28
|
| Rate for Payer: Ohio Health Group HMO |
$18,318.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,885.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,571.85
|
| Rate for Payer: PHCS Commercial |
$23,448.31
|
| Rate for Payer: United Healthcare All Payer |
$21,494.28
|
|
|
AS FX HUMERAL STEM 10-130
|
Facility
|
IP
|
$24,425.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,175.29 |
| Max. Negotiated Rate |
$23,448.31 |
| Rate for Payer: Aetna Commercial |
$18,807.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,051.75
|
| Rate for Payer: Cash Price |
$12,212.66
|
| Rate for Payer: Cigna Commercial |
$20,273.02
|
| Rate for Payer: First Health Commercial |
$23,204.05
|
| Rate for Payer: Humana Commercial |
$20,761.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,028.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,025.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,327.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,494.28
|
| Rate for Payer: Ohio Health Group HMO |
$18,318.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,885.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,571.85
|
| Rate for Payer: PHCS Commercial |
$23,448.31
|
| Rate for Payer: United Healthcare All Payer |
$21,494.28
|
|
