|
PROFEMUR Z FEM S6 STEM CLASSTD
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S6 STEM CLASSTD
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S7 STEM CLASEXT
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S7 STEM CLASEXT
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S7 STEM CLASSTD
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S7 STEM CLASSTD
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S8 STEM CLASEXT
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S8 STEM CLASEXT
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S8 STEM CLASSTD
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S8 STEM CLASSTD
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S9 STEM CLASEXT
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S9 STEM CLASEXT
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S9 STEM CLASSTD
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z FEM S9 STEM CLASSTD
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
PROFEMUR Z REV STEM SZ 9 206MM
|
Facility
|
OP
|
$24,061.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,218.38 |
| Max. Negotiated Rate |
$23,098.80 |
| Rate for Payer: Aetna Commercial |
$18,527.16
|
| Rate for Payer: Anthem Medicaid |
$8,274.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,767.78
|
| Rate for Payer: Cash Price |
$12,030.62
|
| Rate for Payer: Cigna Commercial |
$19,970.84
|
| Rate for Payer: First Health Commercial |
$22,858.19
|
| Rate for Payer: Humana Commercial |
$20,452.06
|
| Rate for Payer: Humana KY Medicaid |
$8,274.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,730.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,757.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,218.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,440.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,173.90
|
| Rate for Payer: Ohio Health Group HMO |
$18,045.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,933.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,602.26
|
| Rate for Payer: PHCS Commercial |
$23,098.80
|
| Rate for Payer: United Healthcare All Payer |
$21,173.90
|
|
|
PROFEMUR Z REV STEM SZ 9 206MM
|
Facility
|
IP
|
$24,061.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,218.38 |
| Max. Negotiated Rate |
$23,098.80 |
| Rate for Payer: Aetna Commercial |
$18,527.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,767.78
|
| Rate for Payer: Cash Price |
$12,030.62
|
| Rate for Payer: Cigna Commercial |
$19,970.84
|
| Rate for Payer: First Health Commercial |
$22,858.19
|
| Rate for Payer: Humana Commercial |
$20,452.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,730.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,757.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,218.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,173.90
|
| Rate for Payer: Ohio Health Group HMO |
$18,045.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,933.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,602.26
|
| Rate for Payer: PHCS Commercial |
$23,098.80
|
| Rate for Payer: United Healthcare All Payer |
$21,173.90
|
|
|
PROF HOLTER MONITOR
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS 93227
|
| Hospital Charge Code |
48000073
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.20 |
| 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 |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
PROF HOLTER MONITOR
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS 93227
|
| Hospital Charge Code |
48000073
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.20 |
| 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 |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| 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 |
$17.07 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$47.06
|
| Rate for Payer: Ambetter Exchange |
$17.07
|
| Rate for Payer: Anthem Medicaid |
$34.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$17.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.07
|
| 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 |
$22.19
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.07
|
|
|
PROFILE 3D ANULOPLSTY RING 36M
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
PROFILE 3D ANULOPLSTY RING 36M
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
PROFILE DRILL 5.0 LONG
|
Facility
|
OP
|
$2,098.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem Medicaid |
$721.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Humana KY Medicaid |
$721.50
|
| Rate for Payer: Kentucky WC Medicaid |
$728.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
PROFILE DRILL 5.0 LONG
|
Facility
|
IP
|
$2,098.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$629.40 |
| Max. Negotiated Rate |
$2,014.08 |
| Rate for Payer: Aetna Commercial |
$1,615.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,636.44
|
| Rate for Payer: Cash Price |
$1,049.00
|
| Rate for Payer: Cigna Commercial |
$1,741.34
|
| Rate for Payer: First Health Commercial |
$1,993.10
|
| Rate for Payer: Humana Commercial |
$1,783.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,720.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,548.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,846.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,573.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,678.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,447.62
|
| Rate for Payer: PHCS Commercial |
$2,014.08
|
| Rate for Payer: United Healthcare All Payer |
$1,846.24
|
|
|
PRO-FRACTIONAL CHEEKS
|
Professional
|
Both
|
$1,400.00
|
|
| Hospital Charge Code |
22200658
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$980.00 |
| 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 |
$1,250.20 |
| 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
|
|
