|
BF HUMERAL HEAD 21*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 21*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 21*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 21*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 21*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 21*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
|
|
|
BF HUMERAL HEAD 24*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 24*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 24*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 24*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 24*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
|
|
|
BF HUMERAL HEAD 24*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 27*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 27*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 27*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 27*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 27*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
|
|
|
BF HUMERAL HEAD 27*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 30*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 30*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 30*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 30*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
|
|
|
BF HUMERAL HEAD 30*56
|
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 30*56
|
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 33*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
|
|
