|
BFB TRAINING EA ADDL 15 MIN OT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
43000037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$23.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$23.73
|
| Rate for Payer: Kentucky WC Medicaid |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BFB TRAINING EA ADDL 15 MIN PT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
42000068
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BFB TRAINING EA ADDL 15 MIN PT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
42000068
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$23.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$23.73
|
| Rate for Payer: Kentucky WC Medicaid |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
B/F EXPANDED HEADS IMP SET
|
Facility
|
IP
|
$79,594.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,347.22 |
| Max. Negotiated Rate |
$76,410.24 |
| Rate for Payer: Aetna Commercial |
$61,287.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,083.32
|
| Rate for Payer: Cash Price |
$39,797.00
|
| Rate for Payer: Cigna Commercial |
$66,063.02
|
| Rate for Payer: First Health Commercial |
$75,614.30
|
| Rate for Payer: Humana Commercial |
$67,654.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,267.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,740.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,878.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,042.72
|
| Rate for Payer: Ohio Health Group HMO |
$59,695.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,347.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,674.14
|
| Rate for Payer: PHCS Commercial |
$76,410.24
|
| Rate for Payer: United Healthcare All Payer |
$70,042.72
|
|
|
B/F EXPANDED HEADS IMP SET
|
Facility
|
OP
|
$79,594.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,347.22 |
| Max. Negotiated Rate |
$76,410.24 |
| Rate for Payer: Aetna Commercial |
$61,287.38
|
| Rate for Payer: Anthem Medicaid |
$27,372.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62,083.32
|
| Rate for Payer: Cash Price |
$39,797.00
|
| Rate for Payer: Cigna Commercial |
$66,063.02
|
| Rate for Payer: First Health Commercial |
$75,614.30
|
| Rate for Payer: Humana Commercial |
$67,654.90
|
| Rate for Payer: Humana KY Medicaid |
$27,372.38
|
| Rate for Payer: Kentucky WC Medicaid |
$27,650.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,267.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,740.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,878.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,921.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$70,042.72
|
| Rate for Payer: Ohio Health Group HMO |
$59,695.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,347.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,674.14
|
| Rate for Payer: PHCS Commercial |
$76,410.24
|
| Rate for Payer: United Healthcare All Payer |
$70,042.72
|
|
|
B/F GLENOID WITH KEEL IMP SET
|
Facility
|
IP
|
$118,222.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,368.86 |
| Max. Negotiated Rate |
$113,493.12 |
| Rate for Payer: Aetna Commercial |
$91,030.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92,213.16
|
| Rate for Payer: Cash Price |
$59,111.00
|
| Rate for Payer: Cigna Commercial |
$98,124.26
|
| Rate for Payer: First Health Commercial |
$112,310.90
|
| Rate for Payer: Humana Commercial |
$100,488.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96,942.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87,247.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,466.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$104,035.36
|
| Rate for Payer: Ohio Health Group HMO |
$88,666.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,644.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,368.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36,648.82
|
| Rate for Payer: PHCS Commercial |
$113,493.12
|
| Rate for Payer: United Healthcare All Payer |
$104,035.36
|
|
|
B/F GLENOID WITH KEEL IMP SET
|
Facility
|
OP
|
$118,222.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,368.86 |
| Max. Negotiated Rate |
$113,493.12 |
| Rate for Payer: Aetna Commercial |
$91,030.94
|
| Rate for Payer: Anthem Medicaid |
$40,656.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92,213.16
|
| Rate for Payer: Cash Price |
$59,111.00
|
| Rate for Payer: Cigna Commercial |
$98,124.26
|
| Rate for Payer: First Health Commercial |
$112,310.90
|
| Rate for Payer: Humana Commercial |
$100,488.70
|
| Rate for Payer: Humana KY Medicaid |
$40,656.55
|
| Rate for Payer: Kentucky WC Medicaid |
$41,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96,942.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87,247.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,466.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$41,472.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$104,035.36
|
| Rate for Payer: Ohio Health Group HMO |
$88,666.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,644.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,368.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36,648.82
|
| Rate for Payer: PHCS Commercial |
$113,493.12
|
| Rate for Payer: United Healthcare All Payer |
$104,035.36
|
|
|
B/F GLENOID WITH PEG IMP SET
|
Facility
|
IP
|
$75,752.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,847.86 |
| Max. Negotiated Rate |
$72,722.69 |
| Rate for Payer: Aetna Commercial |
$58,329.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,087.18
|
| Rate for Payer: Cash Price |
$37,876.40
|
| Rate for Payer: Cigna Commercial |
$62,874.82
|
| Rate for Payer: First Health Commercial |
$71,965.16
|
| Rate for Payer: Humana Commercial |
$64,389.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,117.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,905.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,725.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,662.46
|
| Rate for Payer: Ohio Health Group HMO |
$56,814.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,150.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,847.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,483.37
|
| Rate for Payer: PHCS Commercial |
$72,722.69
|
| Rate for Payer: United Healthcare All Payer |
$66,662.46
|
|
|
B/F GLENOID WITH PEG IMP SET
|
Facility
|
OP
|
$75,752.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,847.86 |
| Max. Negotiated Rate |
$72,722.69 |
| Rate for Payer: Aetna Commercial |
$58,329.66
|
| Rate for Payer: Anthem Medicaid |
$26,051.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,087.18
|
| Rate for Payer: Cash Price |
$37,876.40
|
| Rate for Payer: Cigna Commercial |
$62,874.82
|
| Rate for Payer: First Health Commercial |
$71,965.16
|
| Rate for Payer: Humana Commercial |
$64,389.88
|
| Rate for Payer: Humana KY Medicaid |
$26,051.39
|
| Rate for Payer: Kentucky WC Medicaid |
$26,316.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,117.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,905.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,725.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,574.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,662.46
|
| Rate for Payer: Ohio Health Group HMO |
$56,814.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,150.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,847.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,483.37
|
| Rate for Payer: PHCS Commercial |
$72,722.69
|
| Rate for Payer: United Healthcare All Payer |
$66,662.46
|
|
|
BF HUMERAL HEAD 15*40
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 15*40
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 15*46
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 15*46
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 18*40
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 18*40
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 18*46
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 18*46
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 18*52
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 18*52
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 21*40
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 21*40
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 21*46
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 21*46
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 21*52
|
Facility
|
IP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
|
BF HUMERAL HEAD 21*52
|
Facility
|
OP
|
$9,320.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.65 |
| Max. Negotiated Rate |
$8,947.55 |
| Rate for Payer: Aetna Commercial |
$7,176.68
|
| Rate for Payer: Anthem Medicaid |
$3,205.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,269.88
|
| Rate for Payer: Cash Price |
$4,660.18
|
| Rate for Payer: Cigna Commercial |
$7,735.90
|
| Rate for Payer: First Health Commercial |
$8,854.34
|
| Rate for Payer: Humana Commercial |
$7,922.31
|
| Rate for Payer: Humana KY Medicaid |
$3,205.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,642.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,878.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,796.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,201.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,990.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,864.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,889.31
|
| Rate for Payer: PHCS Commercial |
$8,947.55
|
| Rate for Payer: United Healthcare All Payer |
$8,201.92
|
|
