|
BF ANAT SHOULDR ADAPTOR 42 DEG
|
Facility
|
OP
|
$8,329.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.70 |
| Max. Negotiated Rate |
$7,995.84 |
| Rate for Payer: Aetna Commercial |
$6,413.33
|
| Rate for Payer: Anthem Medicaid |
$2,864.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,496.62
|
| Rate for Payer: Cash Price |
$4,164.50
|
| Rate for Payer: Cigna Commercial |
$6,913.07
|
| Rate for Payer: First Health Commercial |
$7,912.55
|
| Rate for Payer: Humana Commercial |
$7,079.65
|
| Rate for Payer: Humana KY Medicaid |
$2,864.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,829.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,146.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,921.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,329.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,246.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,246.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,747.01
|
| Rate for Payer: PHCS Commercial |
$7,995.84
|
| Rate for Payer: United Healthcare All Payer |
$7,329.52
|
|
|
BFB TRAINING 1ST 15 MINS OT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
43000036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING 1ST 15 MINS OT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
43000036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING 1ST 15 MINS PT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
42000067
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING 1ST 15 MINS PT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
42000067
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.11
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING EA ADDL 15 MIN OT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
43000037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$23.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$23.73
|
| Rate for Payer: Kentucky WC Medicaid |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BFB TRAINING EA ADDL 15 MIN OT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
43000037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BFB TRAINING EA ADDL 15 MIN PT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
42000068
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$23.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$23.73
|
| Rate for Payer: Kentucky WC Medicaid |
$23.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BFB TRAINING EA ADDL 15 MIN PT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
42000068
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
B/F EXPANDED HEADS IMP SET
|
Facility
|
OP
|
$82,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,713.10 |
| Max. Negotiated Rate |
$79,081.92 |
| Rate for Payer: Aetna Commercial |
$63,430.29
|
| Rate for Payer: Anthem Medicaid |
$28,329.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,254.06
|
| Rate for Payer: Cash Price |
$41,188.50
|
| Rate for Payer: Cigna Commercial |
$68,372.91
|
| Rate for Payer: First Health Commercial |
$78,258.15
|
| Rate for Payer: Humana Commercial |
$70,020.45
|
| Rate for Payer: Humana KY Medicaid |
$28,329.45
|
| Rate for Payer: Kentucky WC Medicaid |
$28,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,549.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,794.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,713.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,897.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,491.76
|
| Rate for Payer: Ohio Health Group HMO |
$61,782.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,901.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,667.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,840.13
|
| Rate for Payer: PHCS Commercial |
$79,081.92
|
| Rate for Payer: United Healthcare All Payer |
$72,491.76
|
|
|
B/F EXPANDED HEADS IMP SET
|
Facility
|
IP
|
$82,377.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,713.10 |
| Max. Negotiated Rate |
$79,081.92 |
| Rate for Payer: Aetna Commercial |
$63,430.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,254.06
|
| Rate for Payer: Cash Price |
$41,188.50
|
| Rate for Payer: Cigna Commercial |
$68,372.91
|
| Rate for Payer: First Health Commercial |
$78,258.15
|
| Rate for Payer: Humana Commercial |
$70,020.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,549.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,794.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,713.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,491.76
|
| Rate for Payer: Ohio Health Group HMO |
$61,782.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,901.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,667.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,840.13
|
| Rate for Payer: PHCS Commercial |
$79,081.92
|
| Rate for Payer: United Healthcare All Payer |
$72,491.76
|
|
|
B/F GLENOID WITH KEEL IMP SET
|
Facility
|
IP
|
$123,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,945.30 |
| Max. Negotiated Rate |
$118,224.96 |
| Rate for Payer: Aetna Commercial |
$94,826.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96,057.78
|
| Rate for Payer: Cash Price |
$61,575.50
|
| Rate for Payer: Cigna Commercial |
$102,215.33
|
| Rate for Payer: First Health Commercial |
$116,993.45
|
| Rate for Payer: Humana Commercial |
$104,678.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100,983.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90,885.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,945.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$108,372.88
|
| Rate for Payer: Ohio Health Group HMO |
$92,363.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98,520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107,141.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84,974.19
|
| Rate for Payer: PHCS Commercial |
$118,224.96
|
| Rate for Payer: United Healthcare All Payer |
$108,372.88
|
|
|
B/F GLENOID WITH KEEL IMP SET
|
Facility
|
OP
|
$123,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,945.30 |
| Max. Negotiated Rate |
$118,224.96 |
| Rate for Payer: Aetna Commercial |
$94,826.27
|
| Rate for Payer: Anthem Medicaid |
$42,351.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96,057.78
|
| Rate for Payer: Cash Price |
$61,575.50
|
| Rate for Payer: Cigna Commercial |
$102,215.33
|
| Rate for Payer: First Health Commercial |
$116,993.45
|
| Rate for Payer: Humana Commercial |
$104,678.35
|
| Rate for Payer: Humana KY Medicaid |
$42,351.63
|
| Rate for Payer: Kentucky WC Medicaid |
$42,782.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100,983.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90,885.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,945.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,201.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$108,372.88
|
| Rate for Payer: Ohio Health Group HMO |
$92,363.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98,520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107,141.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84,974.19
|
| Rate for Payer: PHCS Commercial |
$118,224.96
|
| Rate for Payer: United Healthcare All Payer |
$108,372.88
|
|
|
B/F GLENOID WITH PEG IMP SET
|
Facility
|
OP
|
$78,322.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,496.72 |
| Max. Negotiated Rate |
$75,189.50 |
| Rate for Payer: Aetna Commercial |
$60,308.25
|
| Rate for Payer: Anthem Medicaid |
$26,935.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,091.47
|
| Rate for Payer: Cash Price |
$39,161.20
|
| Rate for Payer: Cigna Commercial |
$65,007.59
|
| Rate for Payer: First Health Commercial |
$74,406.28
|
| Rate for Payer: Humana Commercial |
$66,574.04
|
| Rate for Payer: Humana KY Medicaid |
$26,935.07
|
| Rate for Payer: Kentucky WC Medicaid |
$27,209.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,224.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,801.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,496.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,475.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,923.71
|
| Rate for Payer: Ohio Health Group HMO |
$58,741.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,657.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,140.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,042.46
|
| Rate for Payer: PHCS Commercial |
$75,189.50
|
| Rate for Payer: United Healthcare All Payer |
$68,923.71
|
|
|
B/F GLENOID WITH PEG IMP SET
|
Facility
|
IP
|
$78,322.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,496.72 |
| Max. Negotiated Rate |
$75,189.50 |
| Rate for Payer: Aetna Commercial |
$60,308.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,091.47
|
| Rate for Payer: Cash Price |
$39,161.20
|
| Rate for Payer: Cigna Commercial |
$65,007.59
|
| Rate for Payer: First Health Commercial |
$74,406.28
|
| Rate for Payer: Humana Commercial |
$66,574.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,224.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,801.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,496.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,923.71
|
| Rate for Payer: Ohio Health Group HMO |
$58,741.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,657.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,140.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,042.46
|
| Rate for Payer: PHCS Commercial |
$75,189.50
|
| Rate for Payer: United Healthcare All Payer |
$68,923.71
|
|
|
BF HUMERAL HEAD 15*40
|
Facility
|
IP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 15*40
|
Facility
|
OP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem Medicaid |
$3,274.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Humana KY Medicaid |
$3,274.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,307.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 15*46
|
Facility
|
IP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 15*46
|
Facility
|
OP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem Medicaid |
$3,274.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Humana KY Medicaid |
$3,274.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,307.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 18*40
|
Facility
|
OP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem Medicaid |
$3,274.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Humana KY Medicaid |
$3,274.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,307.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 18*40
|
Facility
|
IP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 18*46
|
Facility
|
IP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 18*46
|
Facility
|
OP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem Medicaid |
$3,274.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Humana KY Medicaid |
$3,274.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,307.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 18*52
|
Facility
|
IP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
|
BF HUMERAL HEAD 18*52
|
Facility
|
OP
|
$9,520.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.11 |
| Max. Negotiated Rate |
$9,139.55 |
| Rate for Payer: Aetna Commercial |
$7,330.68
|
| Rate for Payer: Anthem Medicaid |
$3,274.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,425.88
|
| Rate for Payer: Cash Price |
$4,760.18
|
| Rate for Payer: Cigna Commercial |
$7,901.90
|
| Rate for Payer: First Health Commercial |
$9,044.34
|
| Rate for Payer: Humana Commercial |
$8,092.31
|
| Rate for Payer: Humana KY Medicaid |
$3,274.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,307.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,806.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,026.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,856.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,377.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,140.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,616.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,282.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,569.05
|
| Rate for Payer: PHCS Commercial |
$9,139.55
|
| Rate for Payer: United Healthcare All Payer |
$8,377.92
|
|
