|
ZILRETTA 1mg (32mg SDV)
|
Facility
|
OP
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
636T0182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$98.07 |
| Rate for Payer: Aetna Commercial |
$78.66
|
| Rate for Payer: Anthem Medicaid |
$35.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.68
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cigna Commercial |
$84.79
|
| Rate for Payer: First Health Commercial |
$97.05
|
| Rate for Payer: Humana Commercial |
$86.84
|
| Rate for Payer: Humana KY Medicaid |
$35.13
|
| Rate for Payer: Humana Medicare Advantage |
$17.54
|
| Rate for Payer: Kentucky WC Medicaid |
$35.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.90
|
| Rate for Payer: Ohio Health Group HMO |
$76.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.67
|
| Rate for Payer: PHCS Commercial |
$98.07
|
| Rate for Payer: United Healthcare All Payer |
$89.90
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Professional
|
Both
|
$102.16
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
63600182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$102.16 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.16
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Cash Price |
$51.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.37
|
| Rate for Payer: Multiplan PHCS |
$61.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.51
|
| Rate for Payer: UHCCP Medicaid |
$35.76
|
|
|
ZILRETTA 1mg (32mg SDV)
|
Facility
|
IP
|
$3,601.31
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
25004333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$468.17 |
| Max. Negotiated Rate |
$3,457.26 |
| Rate for Payer: Aetna Commercial |
$2,773.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,809.02
|
| Rate for Payer: Cash Price |
$1,800.65
|
| Rate for Payer: Cigna Commercial |
$2,989.09
|
| Rate for Payer: First Health Commercial |
$3,421.24
|
| Rate for Payer: Humana Commercial |
$3,061.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,953.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,657.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,169.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.41
|
| Rate for Payer: PHCS Commercial |
$3,457.26
|
| Rate for Payer: United Healthcare All Payer |
$3,169.15
|
|
|
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 |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| 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 |
$1,565.43 |
| Max. Negotiated Rate |
$11,560.08 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$10,596.74
|
|
|
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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 12-130
|
Facility
|
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 7-130
|
Facility
|
OP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 7-130
|
Facility
|
IP
|
$22,779.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| 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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20,046.31
|
|
|
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 |
$2,961.39 |
| Max. Negotiated Rate |
$21,868.70 |
| 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 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 |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| 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 |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| 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
|
| 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 |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$19,430.89
|
|
|
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 |
$2,870.47 |
| Max. Negotiated Rate |
$21,197.34 |
| 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
|
|
