|
BF HUMERAL STEM 14*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 14*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 14*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 14*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 15*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 15*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 16*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 16*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 17*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 17*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 18*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 18*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 6*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 6*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 6*60
|
Facility
|
OP
|
$115,230.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,979.95 |
| Max. Negotiated Rate |
$110,621.18 |
| Rate for Payer: Aetna Commercial |
$88,727.41
|
| Rate for Payer: Anthem Medicaid |
$39,627.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89,879.71
|
| Rate for Payer: Cash Price |
$57,615.20
|
| Rate for Payer: Cigna Commercial |
$95,641.23
|
| Rate for Payer: First Health Commercial |
$109,468.88
|
| Rate for Payer: Humana Commercial |
$97,945.84
|
| Rate for Payer: Humana KY Medicaid |
$39,627.73
|
| Rate for Payer: Kentucky WC Medicaid |
$40,031.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94,488.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85,040.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,569.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,422.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$101,402.75
|
| Rate for Payer: Ohio Health Group HMO |
$86,422.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,046.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,979.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35,721.42
|
| Rate for Payer: PHCS Commercial |
$110,621.18
|
| Rate for Payer: United Healthcare All Payer |
$101,402.75
|
|
|
BF HUMERAL STEM 6*60
|
Facility
|
IP
|
$115,230.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,979.95 |
| Max. Negotiated Rate |
$110,621.18 |
| Rate for Payer: Aetna Commercial |
$88,727.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89,879.71
|
| Rate for Payer: Cash Price |
$57,615.20
|
| Rate for Payer: Cigna Commercial |
$95,641.23
|
| Rate for Payer: First Health Commercial |
$109,468.88
|
| Rate for Payer: Humana Commercial |
$97,945.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94,488.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85,040.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,569.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$101,402.75
|
| Rate for Payer: Ohio Health Group HMO |
$86,422.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,046.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,979.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35,721.42
|
| Rate for Payer: PHCS Commercial |
$110,621.18
|
| Rate for Payer: United Healthcare All Payer |
$101,402.75
|
|
|
BF HUMERAL STEM 7*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 7*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 7*60
|
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 7*60
|
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 8*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 8*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 8*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 8*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 8*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
|
|
