|
BF HUMERAL STEM 12*200
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 12*200
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 13*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 13*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 14*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 14*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 14*170
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 14*170
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 14*200
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 14*200
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 15*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 15*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 16*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 16*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 17*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 17*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 18*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 18*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 6*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 6*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 6*60
|
Facility
|
OP
|
$119,993.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35,997.96 |
| Max. Negotiated Rate |
$115,193.47 |
| Rate for Payer: Aetna Commercial |
$92,394.76
|
| Rate for Payer: Anthem Medicaid |
$41,265.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93,594.70
|
| Rate for Payer: Cash Price |
$59,996.60
|
| Rate for Payer: Cigna Commercial |
$99,594.36
|
| Rate for Payer: First Health Commercial |
$113,993.54
|
| Rate for Payer: Humana Commercial |
$101,994.22
|
| Rate for Payer: Humana KY Medicaid |
$41,265.66
|
| Rate for Payer: Kentucky WC Medicaid |
$41,685.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98,394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88,554.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,997.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$42,093.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$105,594.02
|
| Rate for Payer: Ohio Health Group HMO |
$89,994.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95,994.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104,394.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82,795.31
|
| Rate for Payer: PHCS Commercial |
$115,193.47
|
| Rate for Payer: United Healthcare All Payer |
$105,594.02
|
|
|
BF HUMERAL STEM 6*60
|
Facility
|
IP
|
$119,993.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35,997.96 |
| Max. Negotiated Rate |
$115,193.47 |
| Rate for Payer: Aetna Commercial |
$92,394.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93,594.70
|
| Rate for Payer: Cash Price |
$59,996.60
|
| Rate for Payer: Cigna Commercial |
$99,594.36
|
| Rate for Payer: First Health Commercial |
$113,993.54
|
| Rate for Payer: Humana Commercial |
$101,994.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98,394.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88,554.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,997.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$105,594.02
|
| Rate for Payer: Ohio Health Group HMO |
$89,994.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95,994.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104,394.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82,795.31
|
| Rate for Payer: PHCS Commercial |
$115,193.47
|
| Rate for Payer: United Healthcare All Payer |
$105,594.02
|
|
|
BF HUMERAL STEM 7*130
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 7*130
|
Facility
|
IP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
|
BF HUMERAL STEM 7*60
|
Facility
|
OP
|
$19,182.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.67 |
| Max. Negotiated Rate |
$18,414.95 |
| Rate for Payer: Aetna Commercial |
$14,770.32
|
| Rate for Payer: Anthem Medicaid |
$6,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,962.15
|
| Rate for Payer: Cash Price |
$9,591.12
|
| Rate for Payer: Cigna Commercial |
$15,921.26
|
| Rate for Payer: First Health Commercial |
$18,223.13
|
| Rate for Payer: Humana Commercial |
$16,304.90
|
| Rate for Payer: Humana KY Medicaid |
$6,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,729.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,156.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,729.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,880.37
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,688.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.75
|
| Rate for Payer: PHCS Commercial |
$18,414.95
|
| Rate for Payer: United Healthcare All Payer |
$16,880.37
|
|
