|
AS FX HUMERAL STEM 11-130
|
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
|
|
|
AS FX HUMERAL STEM 11-130
|
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 11-200
|
Facility
|
IP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 11-200
|
Facility
|
OP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem Medicaid |
$8,653.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Humana KY Medicaid |
$8,653.93
|
| Rate for Payer: Kentucky WC Medicaid |
$8,742.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,827.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 12-130
|
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 12-130
|
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
|
|
|
AS FX HUMERAL STEM 13-130
|
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 13-130
|
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
|
|
|
AS FX HUMERAL STEM 13-200
|
Facility
|
OP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem Medicaid |
$8,653.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Humana KY Medicaid |
$8,653.93
|
| Rate for Payer: Kentucky WC Medicaid |
$8,742.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,827.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 13-200
|
Facility
|
IP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 14-130
|
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
|
|
|
AS FX HUMERAL STEM 14-130
|
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 7-130
|
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
|
|
|
AS FX HUMERAL STEM 7-130
|
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 7-170
|
Facility
|
OP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem Medicaid |
$8,653.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Humana KY Medicaid |
$8,653.93
|
| Rate for Payer: Kentucky WC Medicaid |
$8,742.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,827.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 7-170
|
Facility
|
IP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 8-130
|
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 8-130
|
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
|
|
|
AS FX HUMERAL STEM 9-130
|
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
|
|
|
AS FX HUMERAL STEM 9-130
|
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 9-200
|
Facility
|
OP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem Medicaid |
$8,653.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Humana KY Medicaid |
$8,653.93
|
| Rate for Payer: Kentucky WC Medicaid |
$8,742.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,827.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS FX HUMERAL STEM 9-200
|
Facility
|
IP
|
$25,164.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,271.33 |
| Max. Negotiated Rate |
$24,157.52 |
| Rate for Payer: Aetna Commercial |
$19,376.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.98
|
| Rate for Payer: Cash Price |
$12,582.04
|
| Rate for Payer: Cigna Commercial |
$20,886.19
|
| Rate for Payer: First Health Commercial |
$23,905.88
|
| Rate for Payer: Humana Commercial |
$21,389.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,634.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,571.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,549.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,144.39
|
| Rate for Payer: Ohio Health Group HMO |
$18,873.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,032.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,271.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,800.86
|
| Rate for Payer: PHCS Commercial |
$24,157.52
|
| Rate for Payer: United Healthcare All Payer |
$22,144.39
|
|
|
AS HUMERAL HEAD FX LT 40
|
Facility
|
OP
|
$11,501.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.20 |
| Max. Negotiated Rate |
$11,041.49 |
| Rate for Payer: Aetna Commercial |
$8,856.19
|
| Rate for Payer: Anthem Medicaid |
$3,955.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.21
|
| Rate for Payer: Cash Price |
$5,750.77
|
| Rate for Payer: Cigna Commercial |
$9,546.29
|
| Rate for Payer: First Health Commercial |
$10,926.47
|
| Rate for Payer: Humana Commercial |
$9,776.32
|
| Rate for Payer: Humana KY Medicaid |
$3,955.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,995.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,034.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.48
|
| Rate for Payer: PHCS Commercial |
$11,041.49
|
| Rate for Payer: United Healthcare All Payer |
$10,121.36
|
|
|
AS HUMERAL HEAD FX LT 40
|
Facility
|
IP
|
$11,501.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.20 |
| Max. Negotiated Rate |
$11,041.49 |
| Rate for Payer: Aetna Commercial |
$8,856.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.21
|
| Rate for Payer: Cash Price |
$5,750.77
|
| Rate for Payer: Cigna Commercial |
$9,546.29
|
| Rate for Payer: First Health Commercial |
$10,926.47
|
| Rate for Payer: Humana Commercial |
$9,776.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.48
|
| Rate for Payer: PHCS Commercial |
$11,041.49
|
| Rate for Payer: United Healthcare All Payer |
$10,121.36
|
|
|
AS HUMERAL HEAD FX LT 44
|
Facility
|
IP
|
$11,501.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.20 |
| Max. Negotiated Rate |
$11,041.49 |
| Rate for Payer: Aetna Commercial |
$8,856.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.21
|
| Rate for Payer: Cash Price |
$5,750.77
|
| Rate for Payer: Cigna Commercial |
$9,546.29
|
| Rate for Payer: First Health Commercial |
$10,926.47
|
| Rate for Payer: Humana Commercial |
$9,776.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.48
|
| Rate for Payer: PHCS Commercial |
$11,041.49
|
| Rate for Payer: United Healthcare All Payer |
$10,121.36
|
|
