|
ZIMMER AS HUM STEM FX 14-130
|
Facility
|
IP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER AS HUM STEM FX 7-130
|
Facility
|
OP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem Medicaid |
$8,072.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Humana KY Medicaid |
$8,072.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,154.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,234.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER AS HUM STEM FX 7-130
|
Facility
|
IP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER AS HUM STEM FX 8-130
|
Facility
|
IP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER AS HUM STEM FX 8-130
|
Facility
|
OP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem Medicaid |
$8,072.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Humana KY Medicaid |
$8,072.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,154.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,234.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER AS HUM STEM FX 9-130
|
Facility
|
OP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem Medicaid |
$8,072.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Humana KY Medicaid |
$8,072.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8,154.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,234.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER AS HUM STEM FX 9-130
|
Facility
|
IP
|
$23,472.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,041.75 |
| Max. Negotiated Rate |
$22,533.60 |
| Rate for Payer: Aetna Commercial |
$18,073.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,308.55
|
| Rate for Payer: Cash Price |
$11,736.25
|
| Rate for Payer: Cigna Commercial |
$19,482.17
|
| Rate for Payer: First Health Commercial |
$22,298.88
|
| Rate for Payer: Humana Commercial |
$19,951.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,247.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,322.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,041.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,655.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,604.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,778.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,196.02
|
| Rate for Payer: PHCS Commercial |
$22,533.60
|
| Rate for Payer: United Healthcare All Payer |
$20,655.80
|
|
|
ZIMMER PRESS-FITHUM STEM 7*100
|
Facility
|
OP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem Medicaid |
$7,825.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Humana KY Medicaid |
$7,825.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRESS-FITHUM STEM 7*100
|
Facility
|
IP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRESS-FITHUM STEM 9*110
|
Facility
|
IP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRESS-FITHUM STEM 9*110
|
Facility
|
OP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem Medicaid |
$7,825.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Humana KY Medicaid |
$7,825.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRSS-FT HUM STEM 12*110
|
Facility
|
OP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem Medicaid |
$7,825.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Humana KY Medicaid |
$7,825.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRSS-FT HUM STEM 12*110
|
Facility
|
IP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRSS-FT HUM STEM 14*110
|
Facility
|
OP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem Medicaid |
$7,825.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Humana KY Medicaid |
$7,825.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,904.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,982.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZIMMER PRSS-FT HUM STEM 14*110
|
Facility
|
IP
|
$22,754.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.20 |
| Max. Negotiated Rate |
$21,843.84 |
| Rate for Payer: Aetna Commercial |
$17,520.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,748.12
|
| Rate for Payer: Cash Price |
$11,377.00
|
| Rate for Payer: Cigna Commercial |
$18,885.82
|
| Rate for Payer: First Health Commercial |
$21,616.30
|
| Rate for Payer: Humana Commercial |
$19,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,658.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,792.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,826.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,023.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,065.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,795.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,700.26
|
| Rate for Payer: PHCS Commercial |
$21,843.84
|
| Rate for Payer: United Healthcare All Payer |
$20,023.52
|
|
|
ZINC CHLORIDE 10mg SDV
|
Facility
|
OP
|
$130.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004369
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Aetna Commercial |
$100.63
|
| Rate for Payer: Anthem Medicaid |
$44.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.94
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$108.47
|
| Rate for Payer: First Health Commercial |
$124.16
|
| Rate for Payer: Humana Commercial |
$111.09
|
| Rate for Payer: Humana KY Medicaid |
$44.94
|
| Rate for Payer: Kentucky WC Medicaid |
$45.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.01
|
| Rate for Payer: Ohio Health Group HMO |
$98.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.18
|
| Rate for Payer: PHCS Commercial |
$125.46
|
| Rate for Payer: United Healthcare All Payer |
$115.01
|
|
|
ZINC CHLORIDE 10mg SDV
|
Facility
|
IP
|
$130.69
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004369
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$39.21 |
| Max. Negotiated Rate |
$125.46 |
| Rate for Payer: Aetna Commercial |
$100.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.94
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cigna Commercial |
$108.47
|
| Rate for Payer: First Health Commercial |
$124.16
|
| Rate for Payer: Humana Commercial |
$111.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.01
|
| Rate for Payer: Ohio Health Group HMO |
$98.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.18
|
| Rate for Payer: PHCS Commercial |
$125.46
|
| Rate for Payer: United Healthcare All Payer |
$115.01
|
|
|
ZINC OXIDE PASTE 113 gm
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 53329015644
|
| Hospital Charge Code |
25004446
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem Medicaid |
$1.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Humana KY Medicaid |
$1.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.42
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
ZINC OXIDE PASTE 113 gm
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 53329015644
|
| Hospital Charge Code |
25004446
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.74
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.91
|
| Rate for Payer: First Health Commercial |
$3.33
|
| Rate for Payer: Humana Commercial |
$2.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.09
|
| Rate for Payer: Ohio Health Group HMO |
$2.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.42
|
| Rate for Payer: PHCS Commercial |
$3.37
|
| Rate for Payer: United Healthcare All Payer |
$3.09
|
|
|
ZINC OXIDE PASTE 4 gm
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 53329015683
|
| Hospital Charge Code |
25004458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ZINC OXIDE PASTE 4 gm
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 53329015683
|
| Hospital Charge Code |
25004458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
|
ZINC OXIDE PASTE 57 gm
|
Facility
|
OP
|
$5.14
|
|
|
Service Code
|
NDC 53329015614
|
| Hospital Charge Code |
25004457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Anthem Medicaid |
$1.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.88
|
| Rate for Payer: Humana Commercial |
$4.37
|
| Rate for Payer: Humana KY Medicaid |
$1.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.55
|
| Rate for Payer: PHCS Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Payer |
$4.52
|
|
|
ZINC OXIDE PASTE 57 gm
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
NDC 53329015614
|
| Hospital Charge Code |
25004457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna Commercial |
$4.27
|
| Rate for Payer: First Health Commercial |
$4.88
|
| Rate for Payer: Humana Commercial |
$4.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.52
|
| Rate for Payer: Ohio Health Group HMO |
$3.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.55
|
| Rate for Payer: PHCS Commercial |
$4.93
|
| Rate for Payer: United Healthcare All Payer |
$4.52
|
|
|
ZINC SULFATE 10 MG/10 ML VIAL
|
Facility
|
IP
|
$186.70
|
|
|
Service Code
|
NDC 517610125
|
| Hospital Charge Code |
25003990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.01 |
| Max. Negotiated Rate |
$179.23 |
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.63
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna Commercial |
$154.96
|
| Rate for Payer: First Health Commercial |
$177.37
|
| Rate for Payer: Humana Commercial |
$158.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.30
|
| Rate for Payer: Ohio Health Group HMO |
$140.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.82
|
| Rate for Payer: PHCS Commercial |
$179.23
|
| Rate for Payer: United Healthcare All Payer |
$164.30
|
|
|
ZINC SULFATE 10 MG/10 ML VIAL
|
Facility
|
OP
|
$186.70
|
|
|
Service Code
|
NDC 517610125
|
| Hospital Charge Code |
25003990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.01 |
| Max. Negotiated Rate |
$179.23 |
| Rate for Payer: Aetna Commercial |
$143.76
|
| Rate for Payer: Anthem Medicaid |
$64.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.63
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cigna Commercial |
$154.96
|
| Rate for Payer: First Health Commercial |
$177.37
|
| Rate for Payer: Humana Commercial |
$158.69
|
| Rate for Payer: Humana KY Medicaid |
$64.21
|
| Rate for Payer: Kentucky WC Medicaid |
$64.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.30
|
| Rate for Payer: Ohio Health Group HMO |
$140.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.82
|
| Rate for Payer: PHCS Commercial |
$179.23
|
| Rate for Payer: United Healthcare All Payer |
$164.30
|
|
