|
ZILVER PTX 35*125*5*140
|
Facility
OP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem Medicaid |
$4,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Humana KY Medicaid |
$4,141.16
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
ZILVER PTX 35*125*5*140
|
Facility
IP
|
$12,041.75
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$68,651.52 |
| Rate for Payer: Aetna Commercial |
$9,272.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.56
|
| Rate for Payer: Cash Price |
$6,020.88
|
| Rate for Payer: Cigna Commercial |
$9,994.65
|
| Rate for Payer: First Health Commercial |
$11,439.66
|
| Rate for Payer: Humana Commercial |
$10,235.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.94
|
| Rate for Payer: PHCS Commercial |
$11,560.08
|
|
|
ZIMMER AS HUM STEM FX 10-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 10-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 11-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 11-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 12-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 12-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 13-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 13-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 14-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 14-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 7-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 7-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 8-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 8-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER AS HUM STEM FX 9-130
|
Facility
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem Medicaid |
$7,834.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Humana KY Medicaid |
$7,834.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,913.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,991.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
ZIMMER AS HUM STEM FX 9-130
|
Facility
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,540.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,768.32
|
| Rate for Payer: Cash Price |
$11,389.95
|
| Rate for Payer: Cigna Commercial |
$18,907.32
|
| Rate for Payer: First Health Commercial |
$21,640.90
|
| Rate for Payer: Humana Commercial |
$19,362.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,679.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,811.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,833.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,046.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,084.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,961.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,061.77
|
| Rate for Payer: PHCS Commercial |
$21,868.70
|
|
|
ZIMMER PRESS-FITHUM STEM 7*100
|
Facility
OP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem Medicaid |
$7,593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Humana KY Medicaid |
$7,593.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZIMMER PRESS-FITHUM STEM 7*100
|
Facility
IP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
|
|
ZIMMER PRESS-FITHUM STEM 9*110
|
Facility
OP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem Medicaid |
$7,593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Humana KY Medicaid |
$7,593.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZIMMER PRESS-FITHUM STEM 9*110
|
Facility
IP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
|
|
ZIMMER PRSS-FT HUM STEM 12*110
|
Facility
IP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
|
|
ZIMMER PRSS-FT HUM STEM 12*110
|
Facility
OP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem Medicaid |
$7,593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Humana KY Medicaid |
$7,593.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
ZIMMER PRSS-FT HUM STEM 14*110
|
Facility
OP
|
$22,080.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$17,002.03
|
| Rate for Payer: Anthem Medicaid |
$7,593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,222.84
|
| Rate for Payer: Cash Price |
$11,040.28
|
| Rate for Payer: Cigna Commercial |
$18,326.86
|
| Rate for Payer: First Health Commercial |
$20,976.53
|
| Rate for Payer: Humana Commercial |
$18,768.48
|
| Rate for Payer: Humana KY Medicaid |
$7,593.50
|
| Rate for Payer: Kentucky WC Medicaid |
$7,670.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,106.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,295.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,624.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,430.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,560.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,416.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,870.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.97
|
| Rate for Payer: PHCS Commercial |
$21,197.34
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
