|
ASCORBID ACID (VIT 250MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
25000262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
ASCORBID ACID (VIT 250MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 50268086015
|
| Hospital Charge Code |
25000262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
ASENDIN (AMOXAPINE) 25MG TAB
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
NDC 591571301
|
| Hospital Charge Code |
25000263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.32
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
ASENDIN (AMOXAPINE) 25MG TAB
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
NDC 591571301
|
| Hospital Charge Code |
25000263
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.32
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
AS FEMUR STEM NEU 017*117 5 DE
|
Facility
|
OP
|
$20,915.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,274.50 |
| Max. Negotiated Rate |
$20,078.40 |
| Rate for Payer: Aetna Commercial |
$16,104.55
|
| Rate for Payer: Anthem Medicaid |
$7,192.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,313.70
|
| Rate for Payer: Cash Price |
$10,457.50
|
| Rate for Payer: Cigna Commercial |
$17,359.45
|
| Rate for Payer: First Health Commercial |
$19,869.25
|
| Rate for Payer: Humana Commercial |
$17,777.75
|
| Rate for Payer: Humana KY Medicaid |
$7,192.67
|
| Rate for Payer: Kentucky WC Medicaid |
$7,265.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,150.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,435.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,274.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,336.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,405.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,196.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,431.35
|
| Rate for Payer: PHCS Commercial |
$20,078.40
|
| Rate for Payer: United Healthcare All Payer |
$18,405.20
|
|
|
AS FEMUR STEM NEU 017*117 5 DE
|
Facility
|
IP
|
$20,915.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,274.50 |
| Max. Negotiated Rate |
$20,078.40 |
| Rate for Payer: Aetna Commercial |
$16,104.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,313.70
|
| Rate for Payer: Cash Price |
$10,457.50
|
| Rate for Payer: Cigna Commercial |
$17,359.45
|
| Rate for Payer: First Health Commercial |
$19,869.25
|
| Rate for Payer: Humana Commercial |
$17,777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,150.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,435.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,405.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,196.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,431.35
|
| Rate for Payer: PHCS Commercial |
$20,078.40
|
| Rate for Payer: United Healthcare All Payer |
$18,405.20
|
|
|
AS FX HUMERAL HEAD 40 L
|
Facility
|
OP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem Medicaid |
$4,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Humana KY Medicaid |
$4,169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,211.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,252.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 40 L
|
Facility
|
IP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 40 R
|
Facility
|
OP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem Medicaid |
$4,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Humana KY Medicaid |
$4,169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,211.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,252.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 40 R
|
Facility
|
IP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 44 L
|
Facility
|
OP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem Medicaid |
$4,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Humana KY Medicaid |
$4,169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,211.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,252.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 44 L
|
Facility
|
IP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 44 R
|
Facility
|
OP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem Medicaid |
$4,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Humana KY Medicaid |
$4,169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,211.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,252.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 44 R
|
Facility
|
IP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 48 L
|
Facility
|
OP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem Medicaid |
$4,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Humana KY Medicaid |
$4,169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,211.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,252.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 48 L
|
Facility
|
IP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 48 R
|
Facility
|
OP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem Medicaid |
$4,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Humana KY Medicaid |
$4,169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,211.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,252.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL HEAD 48 R
|
Facility
|
IP
|
$12,123.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,636.91 |
| Max. Negotiated Rate |
$11,638.11 |
| Rate for Payer: Aetna Commercial |
$9,334.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,455.96
|
| Rate for Payer: Cash Price |
$6,061.52
|
| Rate for Payer: Cigna Commercial |
$10,062.11
|
| Rate for Payer: First Health Commercial |
$11,516.88
|
| Rate for Payer: Humana Commercial |
$10,304.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,940.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,946.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,636.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,668.27
|
| Rate for Payer: Ohio Health Group HMO |
$9,092.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,698.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,547.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,364.89
|
| Rate for Payer: PHCS Commercial |
$11,638.11
|
| Rate for Payer: United Healthcare All Payer |
$10,668.27
|
|
|
AS FX HUMERAL STEM 10-130
|
Facility
|
IP
|
$25,163.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,548.90 |
| Max. Negotiated Rate |
$24,156.48 |
| Rate for Payer: Aetna Commercial |
$19,375.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.14
|
| Rate for Payer: Cash Price |
$12,581.50
|
| Rate for Payer: Cigna Commercial |
$20,885.29
|
| Rate for Payer: First Health Commercial |
$23,904.85
|
| Rate for Payer: Humana Commercial |
$21,388.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,633.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,570.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,548.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,143.44
|
| Rate for Payer: Ohio Health Group HMO |
$18,872.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,891.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,362.47
|
| Rate for Payer: PHCS Commercial |
$24,156.48
|
| Rate for Payer: United Healthcare All Payer |
$22,143.44
|
|
|
AS FX HUMERAL STEM 10-130
|
Facility
|
OP
|
$25,163.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,548.90 |
| Max. Negotiated Rate |
$24,156.48 |
| Rate for Payer: Aetna Commercial |
$19,375.51
|
| Rate for Payer: Anthem Medicaid |
$8,653.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.14
|
| Rate for Payer: Cash Price |
$12,581.50
|
| Rate for Payer: Cigna Commercial |
$20,885.29
|
| Rate for Payer: First Health Commercial |
$23,904.85
|
| Rate for Payer: Humana Commercial |
$21,388.55
|
| Rate for Payer: Humana KY Medicaid |
$8,653.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,741.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,633.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,570.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,548.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,827.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,143.44
|
| Rate for Payer: Ohio Health Group HMO |
$18,872.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,891.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,362.47
|
| Rate for Payer: PHCS Commercial |
$24,156.48
|
| Rate for Payer: United Healthcare All Payer |
$22,143.44
|
|
|
AS FX HUMERAL STEM 11-130
|
Facility
|
OP
|
$25,163.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,548.90 |
| Max. Negotiated Rate |
$24,156.48 |
| Rate for Payer: Aetna Commercial |
$19,375.51
|
| Rate for Payer: Anthem Medicaid |
$8,653.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.14
|
| Rate for Payer: Cash Price |
$12,581.50
|
| Rate for Payer: Cigna Commercial |
$20,885.29
|
| Rate for Payer: First Health Commercial |
$23,904.85
|
| Rate for Payer: Humana Commercial |
$21,388.55
|
| Rate for Payer: Humana KY Medicaid |
$8,653.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,741.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,633.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,570.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,548.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,827.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,143.44
|
| Rate for Payer: Ohio Health Group HMO |
$18,872.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,891.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,362.47
|
| Rate for Payer: PHCS Commercial |
$24,156.48
|
| Rate for Payer: United Healthcare All Payer |
$22,143.44
|
|
|
AS FX HUMERAL STEM 11-130
|
Facility
|
IP
|
$25,163.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,548.90 |
| Max. Negotiated Rate |
$24,156.48 |
| Rate for Payer: Aetna Commercial |
$19,375.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.14
|
| Rate for Payer: Cash Price |
$12,581.50
|
| Rate for Payer: Cigna Commercial |
$20,885.29
|
| Rate for Payer: First Health Commercial |
$23,904.85
|
| Rate for Payer: Humana Commercial |
$21,388.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,633.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,570.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,548.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,143.44
|
| Rate for Payer: Ohio Health Group HMO |
$18,872.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,891.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,362.47
|
| Rate for Payer: PHCS Commercial |
$24,156.48
|
| Rate for Payer: United Healthcare All Payer |
$22,143.44
|
|
|
AS FX HUMERAL STEM 11-200
|
Facility
|
OP
|
$25,922.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,776.60 |
| Max. Negotiated Rate |
$24,885.12 |
| Rate for Payer: Aetna Commercial |
$19,959.94
|
| Rate for Payer: Anthem Medicaid |
$8,914.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,219.16
|
| Rate for Payer: Cash Price |
$12,961.00
|
| Rate for Payer: Cigna Commercial |
$21,515.26
|
| Rate for Payer: First Health Commercial |
$24,625.90
|
| Rate for Payer: Humana Commercial |
$22,033.70
|
| Rate for Payer: Humana KY Medicaid |
$8,914.58
|
| Rate for Payer: Kentucky WC Medicaid |
$9,005.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,256.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,130.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,776.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,093.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,811.36
|
| Rate for Payer: Ohio Health Group HMO |
$19,441.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,552.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,886.18
|
| Rate for Payer: PHCS Commercial |
$24,885.12
|
| Rate for Payer: United Healthcare All Payer |
$22,811.36
|
|
|
AS FX HUMERAL STEM 11-200
|
Facility
|
IP
|
$25,922.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,776.60 |
| Max. Negotiated Rate |
$24,885.12 |
| Rate for Payer: Aetna Commercial |
$19,959.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,219.16
|
| Rate for Payer: Cash Price |
$12,961.00
|
| Rate for Payer: Cigna Commercial |
$21,515.26
|
| Rate for Payer: First Health Commercial |
$24,625.90
|
| Rate for Payer: Humana Commercial |
$22,033.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,256.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,130.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,776.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,811.36
|
| Rate for Payer: Ohio Health Group HMO |
$19,441.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,552.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,886.18
|
| Rate for Payer: PHCS Commercial |
$24,885.12
|
| Rate for Payer: United Healthcare All Payer |
$22,811.36
|
|
|
AS FX HUMERAL STEM 12-130
|
Facility
|
IP
|
$25,163.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,548.90 |
| Max. Negotiated Rate |
$24,156.48 |
| Rate for Payer: Aetna Commercial |
$19,375.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,627.14
|
| Rate for Payer: Cash Price |
$12,581.50
|
| Rate for Payer: Cigna Commercial |
$20,885.29
|
| Rate for Payer: First Health Commercial |
$23,904.85
|
| Rate for Payer: Humana Commercial |
$21,388.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,633.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,570.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,548.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,143.44
|
| Rate for Payer: Ohio Health Group HMO |
$18,872.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,891.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,362.47
|
| Rate for Payer: PHCS Commercial |
$24,156.48
|
| Rate for Payer: United Healthcare All Payer |
$22,143.44
|
|
