|
BF HUMERAL HEAD 36*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 36*56
|
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 36*56
|
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 39*56
|
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 39*56
|
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 42*56
|
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 42*56
|
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 STEM 10*130
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 10*130
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 10*170
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 10*170
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 10*200
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 10*200
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 11*130
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 11*130
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 12*130
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 12*130
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 12*170
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 12*170
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 12*200
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 12*200
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 13*130
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 13*130
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 14*130
|
Facility
|
OP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem Medicaid |
$6,390.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Humana KY Medicaid |
$6,390.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
|
BF HUMERAL STEM 14*130
|
Facility
|
IP
|
$18,582.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.75 |
| Max. Negotiated Rate |
$17,839.41 |
| Rate for Payer: Aetna Commercial |
$14,308.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,494.52
|
| Rate for Payer: Cash Price |
$9,291.36
|
| Rate for Payer: Cigna Commercial |
$15,423.66
|
| Rate for Payer: First Health Commercial |
$17,653.58
|
| Rate for Payer: Humana Commercial |
$15,795.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.79
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.64
|
| Rate for Payer: PHCS Commercial |
$17,839.41
|
| Rate for Payer: United Healthcare All Payer |
$16,352.79
|
|
