|
AS HUMERAL HEAD FX LT 44
|
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 48
|
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 48
|
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 RT 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 RT 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 RT 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
|
|
|
AS HUMERAL HEAD FX RT 44
|
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 RT 48
|
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 RT 48
|
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 STEM 7-170
|
Facility
|
IP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM 7-170
|
Facility
|
OP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem Medicaid |
$7,997.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Humana KY Medicaid |
$7,997.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,078.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM FX 11-200
|
Facility
|
OP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem Medicaid |
$7,997.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Humana KY Medicaid |
$7,997.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,078.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM FX 11-200
|
Facility
|
IP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM FX13200
|
Facility
|
OP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem Medicaid |
$7,997.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Humana KY Medicaid |
$7,997.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,078.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM FX13200
|
Facility
|
IP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM FX 9-200
|
Facility
|
OP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem Medicaid |
$7,997.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Humana KY Medicaid |
$7,997.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,078.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,157.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS HUMERAL STEM FX 9-200
|
Facility
|
IP
|
$23,254.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,023.07 |
| Max. Negotiated Rate |
$22,324.22 |
| Rate for Payer: Aetna Commercial |
$17,905.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,138.43
|
| Rate for Payer: Cash Price |
$11,627.20
|
| Rate for Payer: Cigna Commercial |
$19,301.15
|
| Rate for Payer: First Health Commercial |
$22,091.68
|
| Rate for Payer: Humana Commercial |
$19,766.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,068.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,161.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,976.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,463.87
|
| Rate for Payer: Ohio Health Group HMO |
$17,440.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,650.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,023.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,208.86
|
| Rate for Payer: PHCS Commercial |
$22,324.22
|
| Rate for Payer: United Healthcare All Payer |
$20,463.87
|
|
|
AS INVERSE GLENDOID HEAD 36MM
|
Facility
|
IP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
AS INVERSE GLENDOID HEAD 36MM
|
Facility
|
OP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem Medicaid |
$3,423.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Humana KY Medicaid |
$3,423.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,458.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
AS INVERSE GLND FIX BASE PLATE
|
Facility
|
IP
|
$11,793.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.16 |
| Max. Negotiated Rate |
$11,321.81 |
| Rate for Payer: Aetna Commercial |
$9,081.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,198.97
|
| Rate for Payer: Cash Price |
$5,896.77
|
| Rate for Payer: Cigna Commercial |
$9,788.65
|
| Rate for Payer: First Health Commercial |
$11,203.87
|
| Rate for Payer: Humana Commercial |
$10,024.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,670.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,703.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,378.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,845.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,656.00
|
| Rate for Payer: PHCS Commercial |
$11,321.81
|
| Rate for Payer: United Healthcare All Payer |
$10,378.32
|
|
|
AS INVERSE GLND FIX BASE PLATE
|
Facility
|
OP
|
$11,793.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.16 |
| Max. Negotiated Rate |
$11,321.81 |
| Rate for Payer: Aetna Commercial |
$9,081.03
|
| Rate for Payer: Anthem Medicaid |
$4,055.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,198.97
|
| Rate for Payer: Cash Price |
$5,896.77
|
| Rate for Payer: Cigna Commercial |
$9,788.65
|
| Rate for Payer: First Health Commercial |
$11,203.87
|
| Rate for Payer: Humana Commercial |
$10,024.52
|
| Rate for Payer: Humana KY Medicaid |
$4,055.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,097.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,670.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,703.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,137.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,378.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,845.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,656.00
|
| Rate for Payer: PHCS Commercial |
$11,321.81
|
| Rate for Payer: United Healthcare All Payer |
$10,378.32
|
|
|
AS INVERSE GLND HD 40MM
|
Facility
|
OP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem Medicaid |
$3,423.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Humana KY Medicaid |
$3,423.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,458.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
AS INVERSE GLND HD 40MM
|
Facility
|
IP
|
$9,954.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.02 |
| Max. Negotiated Rate |
$9,555.84 |
| Rate for Payer: Aetna Commercial |
$7,664.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,764.12
|
| Rate for Payer: Cash Price |
$4,977.00
|
| Rate for Payer: Cigna Commercial |
$8,261.82
|
| Rate for Payer: First Health Commercial |
$9,456.30
|
| Rate for Payer: Humana Commercial |
$8,460.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,162.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,346.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,986.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,759.52
|
| Rate for Payer: Ohio Health Group HMO |
$7,465.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,085.74
|
| Rate for Payer: PHCS Commercial |
$9,555.84
|
| Rate for Payer: United Healthcare All Payer |
$8,759.52
|
|
|
AS INVERSE HUM CUP 0 DEG +6MM
|
Facility
|
IP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INVERSE HUM CUP 0 DEG +6MM
|
Facility
|
OP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem Medicaid |
$3,017.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Humana KY Medicaid |
$3,017.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
