|
FEMUR AXLE LGN HK SZ 5
|
Facility
|
OP
|
$3,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,160.70 |
| Max. Negotiated Rate |
$3,714.24 |
| Rate for Payer: Aetna Commercial |
$2,979.13
|
| Rate for Payer: Anthem Medicaid |
$1,330.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.82
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$3,211.27
|
| Rate for Payer: First Health Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial |
$3,288.65
|
| Rate for Payer: Humana KY Medicaid |
$1,330.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,366.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.61
|
| Rate for Payer: PHCS Commercial |
$3,714.24
|
| Rate for Payer: United Healthcare All Payer |
$3,404.72
|
|
|
FEMUR AXLE LGN HK SZ 5
|
Facility
|
IP
|
$3,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,160.70 |
| Max. Negotiated Rate |
$3,714.24 |
| Rate for Payer: Aetna Commercial |
$2,979.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.82
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$3,211.27
|
| Rate for Payer: First Health Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial |
$3,288.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,366.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.61
|
| Rate for Payer: PHCS Commercial |
$3,714.24
|
| Rate for Payer: United Healthcare All Payer |
$3,404.72
|
|
|
FEMUR AXLE LGN HK SZ 7
|
Facility
|
IP
|
$3,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,160.70 |
| Max. Negotiated Rate |
$3,714.24 |
| Rate for Payer: Aetna Commercial |
$2,979.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.82
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$3,211.27
|
| Rate for Payer: First Health Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial |
$3,288.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,366.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.61
|
| Rate for Payer: PHCS Commercial |
$3,714.24
|
| Rate for Payer: United Healthcare All Payer |
$3,404.72
|
|
|
FEMUR AXLE LGN HK SZ 7
|
Facility
|
OP
|
$3,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,160.70 |
| Max. Negotiated Rate |
$3,714.24 |
| Rate for Payer: Aetna Commercial |
$2,979.13
|
| Rate for Payer: Anthem Medicaid |
$1,330.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.82
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$3,211.27
|
| Rate for Payer: First Health Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial |
$3,288.65
|
| Rate for Payer: Humana KY Medicaid |
$1,330.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,366.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.61
|
| Rate for Payer: PHCS Commercial |
$3,714.24
|
| Rate for Payer: United Healthcare All Payer |
$3,404.72
|
|
|
FEMUR ELEOS RESURFACING SZ 2 L
|
Facility
|
IP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURFACING SZ 2 L
|
Facility
|
OP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem Medicaid |
$12,095.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Humana KY Medicaid |
$12,095.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,218.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURFACING SZ 3 L
|
Facility
|
OP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem Medicaid |
$12,095.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Humana KY Medicaid |
$12,095.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,218.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURFACING SZ 3 L
|
Facility
|
IP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURFACING SZ 4
|
Facility
|
IP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURFACING SZ 4
|
Facility
|
OP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem Medicaid |
$12,095.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Humana KY Medicaid |
$12,095.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,218.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURF SZ 2 R
|
Facility
|
OP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem Medicaid |
$12,095.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Humana KY Medicaid |
$12,095.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,218.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURF SZ 2 R
|
Facility
|
IP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURF SZ 3 R
|
Facility
|
OP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem Medicaid |
$12,095.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Humana KY Medicaid |
$12,095.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,218.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURF SZ 3 R
|
Facility
|
IP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURF SZ 4 R
|
Facility
|
OP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem Medicaid |
$12,095.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Humana KY Medicaid |
$12,095.82
|
| Rate for Payer: Kentucky WC Medicaid |
$12,218.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR ELEOS RESURF SZ 4 R
|
Facility
|
IP
|
$35,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,551.75 |
| Max. Negotiated Rate |
$33,765.60 |
| Rate for Payer: Aetna Commercial |
$27,082.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,434.55
|
| Rate for Payer: Cash Price |
$17,586.25
|
| Rate for Payer: Cigna Commercial |
$29,193.17
|
| Rate for Payer: First Health Commercial |
$33,413.88
|
| Rate for Payer: Humana Commercial |
$29,896.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,841.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,957.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,951.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,379.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,600.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,269.03
|
| Rate for Payer: PHCS Commercial |
$33,765.60
|
| Rate for Payer: United Healthcare All Payer |
$30,951.80
|
|
|
FEMUR FIXED BEARING LT 11MM
|
Facility
|
IP
|
$9,068.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,720.44 |
| Max. Negotiated Rate |
$8,705.40 |
| Rate for Payer: Aetna Commercial |
$6,982.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,073.13
|
| Rate for Payer: Cash Price |
$4,534.06
|
| Rate for Payer: Cigna Commercial |
$7,526.54
|
| Rate for Payer: First Health Commercial |
$8,614.71
|
| Rate for Payer: Humana Commercial |
$7,707.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,435.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,692.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,720.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,979.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,801.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,254.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,889.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,257.00
|
| Rate for Payer: PHCS Commercial |
$8,705.40
|
| Rate for Payer: United Healthcare All Payer |
$7,979.95
|
|
|
FEMUR FIXED BEARING LT 11MM
|
Facility
|
OP
|
$9,068.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,720.44 |
| Max. Negotiated Rate |
$8,705.40 |
| Rate for Payer: Aetna Commercial |
$6,982.45
|
| Rate for Payer: Anthem Medicaid |
$3,118.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,073.13
|
| Rate for Payer: Cash Price |
$4,534.06
|
| Rate for Payer: Cigna Commercial |
$7,526.54
|
| Rate for Payer: First Health Commercial |
$8,614.71
|
| Rate for Payer: Humana Commercial |
$7,707.90
|
| Rate for Payer: Humana KY Medicaid |
$3,118.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,150.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,435.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,692.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,720.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,181.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,979.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,801.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,254.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,889.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,257.00
|
| Rate for Payer: PHCS Commercial |
$8,705.40
|
| Rate for Payer: United Healthcare All Payer |
$7,979.95
|
|
|
FEMUR LT (2V)
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
32000098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
FEMUR LT (2V)
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
32000098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Ambetter Exchange |
$32.13
|
| Rate for Payer: Anthem Medicaid |
$24.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.56
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$50.77
|
| Rate for Payer: Humana Medicaid |
$24.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.66
|
| Rate for Payer: Molina Healthcare Passport |
$24.18
|
| Rate for Payer: Multiplan PHCS |
$338.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$197.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.13
|
|
|
FEMUR LT (2V)
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
32000098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$193.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$193.96
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$195.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.16
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
FEMUR LT (2V)(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
320P0098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Ambetter Exchange |
$32.13
|
| Rate for Payer: Anthem Medicaid |
$24.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.56
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$50.77
|
| Rate for Payer: Humana Medicaid |
$24.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.66
|
| Rate for Payer: Molina Healthcare Passport |
$24.18
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.77
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.13
|
|
|
FEMUR LT (2V)(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
320T0098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
FEMUR LT (2V)(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
320T0098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
FEMUR PSN CR CMT NAR SZ 10 L
|
Facility
|
OP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem Medicaid |
$6,227.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Humana KY Medicaid |
$6,227.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,290.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,352.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
