|
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
|
|
|
AS FX HUMERAL STEM 13-130
|
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 13-130
|
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 13-200
|
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 13-200
|
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 14-130
|
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 14-130
|
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 7-130
|
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 7-130
|
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 7-170
|
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 7-170
|
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 8-130
|
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 8-130
|
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 9-130
|
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 9-130
|
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 9-200
|
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 9-200
|
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 HUMERAL HEAD FX LT 40
|
Facility
|
OP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem Medicaid |
$4,039.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Humana KY Medicaid |
$4,039.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,080.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,120.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX LT 40
|
Facility
|
IP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX LT 44
|
Facility
|
IP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX LT 44
|
Facility
|
OP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem Medicaid |
$4,039.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Humana KY Medicaid |
$4,039.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,080.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,120.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX LT 48
|
Facility
|
IP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX LT 48
|
Facility
|
OP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem Medicaid |
$4,039.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Humana KY Medicaid |
$4,039.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,080.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,120.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX RT 40
|
Facility
|
OP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem Medicaid |
$4,039.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Humana KY Medicaid |
$4,039.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,080.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,120.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
|
AS HUMERAL HEAD FX RT 40
|
Facility
|
IP
|
$11,746.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,523.95 |
| Max. Negotiated Rate |
$11,276.63 |
| Rate for Payer: Aetna Commercial |
$9,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,162.26
|
| Rate for Payer: Cash Price |
$5,873.24
|
| Rate for Payer: Cigna Commercial |
$9,749.59
|
| Rate for Payer: First Health Commercial |
$11,159.17
|
| Rate for Payer: Humana Commercial |
$9,984.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,668.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,523.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,336.91
|
| Rate for Payer: Ohio Health Group HMO |
$8,809.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,397.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,219.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,105.08
|
| Rate for Payer: PHCS Commercial |
$11,276.63
|
| Rate for Payer: United Healthcare All Payer |
$10,336.91
|
|
