|
PROFEMUR Z FEM S6 STEM CLASSTD
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S7 STEM CLASEXT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S7 STEM CLASEXT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S7 STEM CLASSTD
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S7 STEM CLASSTD
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S8 STEM CLASEXT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S8 STEM CLASEXT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S8 STEM CLASSTD
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S8 STEM CLASSTD
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S9 STEM CLASEXT
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S9 STEM CLASEXT
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S9 STEM CLASSTD
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z FEM S9 STEM CLASSTD
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
PROFEMUR Z REV STEM SZ 9 206MM
|
Facility
|
IP
|
$23,352.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.88 |
| Max. Negotiated Rate |
$22,418.83 |
| Rate for Payer: Aetna Commercial |
$17,981.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,215.30
|
| Rate for Payer: Cash Price |
$11,676.48
|
| Rate for Payer: Cigna Commercial |
$19,382.95
|
| Rate for Payer: First Health Commercial |
$22,185.30
|
| Rate for Payer: Humana Commercial |
$19,850.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,149.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,234.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,005.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,550.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,514.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,670.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,035.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,239.41
|
| Rate for Payer: PHCS Commercial |
$22,418.83
|
| Rate for Payer: United Healthcare All Payer |
$20,550.60
|
|
|
PROFEMUR Z REV STEM SZ 9 206MM
|
Facility
|
OP
|
$23,352.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,035.88 |
| Max. Negotiated Rate |
$22,418.83 |
| Rate for Payer: Aetna Commercial |
$17,981.77
|
| Rate for Payer: Anthem Medicaid |
$8,031.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,215.30
|
| Rate for Payer: Cash Price |
$11,676.48
|
| Rate for Payer: Cigna Commercial |
$19,382.95
|
| Rate for Payer: First Health Commercial |
$22,185.30
|
| Rate for Payer: Humana Commercial |
$19,850.01
|
| Rate for Payer: Humana KY Medicaid |
$8,031.08
|
| Rate for Payer: Kentucky WC Medicaid |
$8,112.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,149.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,234.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,005.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,192.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,550.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,514.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,670.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,035.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,239.41
|
| Rate for Payer: PHCS Commercial |
$22,418.83
|
| Rate for Payer: United Healthcare All Payer |
$20,550.60
|
|
|
PROF HOLTER MONITOR
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 93227
|
| Hospital Charge Code |
48000073
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.12
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.24
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
PROF HOLTER MONITOR
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 93227
|
| Hospital Charge Code |
48000073
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$47.06
|
| Rate for Payer: Anthem Medicaid |
$34.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$42.23
|
| Rate for Payer: Healthspan PPO |
$44.24
|
| Rate for Payer: Humana Medicaid |
$34.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.38
|
| Rate for Payer: Molina Healthcare Passport |
$34.69
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.80
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.04
|
|
|
PROF HOLTER MONITOR
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 93227
|
| Hospital Charge Code |
48000073
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$35.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.12
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Humana KY Medicaid |
$35.77
|
| Rate for Payer: Kentucky WC Medicaid |
$36.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.24
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
PROFILE 3D ANULOPLSTY RING 36M
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
PROFILE 3D ANULOPLSTY RING 36M
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
PROFILE DRILL 5.0 LONG
|
Facility
|
OP
|
$2,085.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.05 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Aetna Commercial |
$1,605.45
|
| Rate for Payer: Anthem Medicaid |
$717.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.30
|
| Rate for Payer: Cash Price |
$1,042.50
|
| Rate for Payer: Cigna Commercial |
$1,730.55
|
| Rate for Payer: First Health Commercial |
$1,980.75
|
| Rate for Payer: Humana Commercial |
$1,772.25
|
| Rate for Payer: Humana KY Medicaid |
$717.03
|
| Rate for Payer: Kentucky WC Medicaid |
$724.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$731.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.35
|
| Rate for Payer: PHCS Commercial |
$2,001.60
|
| Rate for Payer: United Healthcare All Payer |
$1,834.80
|
|
|
PROFILE DRILL 5.0 LONG
|
Facility
|
IP
|
$2,085.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.05 |
| Max. Negotiated Rate |
$2,001.60 |
| Rate for Payer: Aetna Commercial |
$1,605.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.30
|
| Rate for Payer: Cash Price |
$1,042.50
|
| Rate for Payer: Cigna Commercial |
$1,730.55
|
| Rate for Payer: First Health Commercial |
$1,980.75
|
| Rate for Payer: Humana Commercial |
$1,772.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.35
|
| Rate for Payer: PHCS Commercial |
$2,001.60
|
| Rate for Payer: United Healthcare All Payer |
$1,834.80
|
|
|
PRO-FRACTIONAL CHEEKS
|
Professional
|
Both
|
$1,400.00
|
|
| Hospital Charge Code |
22200658
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
|
|
Pro-fractional cheeks-PP#1 50%
|
Professional
|
Both
|
$1,786.00
|
|
| Hospital Charge Code |
22200659
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$625.10 |
| Max. Negotiated Rate |
$1,786.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,786.00
|
| Rate for Payer: Cash Price |
$893.00
|
| Rate for Payer: Multiplan PHCS |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,250.20
|
| Rate for Payer: UHCCP Medicaid |
$625.10
|
|
|
Pro-fractionl cheek-PP#2/3 25%
|
Professional
|
Both
|
$892.00
|
|
| Hospital Charge Code |
22200677
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$892.00
|
| Rate for Payer: Cash Price |
$446.00
|
| Rate for Payer: Multiplan PHCS |
$535.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$624.40
|
| Rate for Payer: UHCCP Medicaid |
$312.20
|
|
