|
FEMUR PSN CR CMT NAR SZ 10 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 10 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 10 R
|
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
|
|
|
FEMUR PSN CR CMT NAR SZ 11 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 11 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
|
|
|
FEMUR PSN CR CMT NAR SZ 11 R
|
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
|
|
|
FEMUR PSN CR CMT NAR SZ 11 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 24 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
|
|
|
FEMUR PSN CR CMT NAR SZ 24 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 4 R
|
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
|
|
|
FEMUR PSN CR CMT NAR SZ 4 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 5 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 5 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
|
|
|
FEMUR PSN CR CMT NAR SZ 6 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
|
|
|
FEMUR PSN CR CMT NAR SZ 6 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 6 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 6 R
|
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
|
|
|
FEMUR PSN CR CMT NAR SZ 7 L
|
Facility
|
OP
|
$16,980.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,094.00 |
| Max. Negotiated Rate |
$16,300.80 |
| Rate for Payer: Aetna Commercial |
$13,074.60
|
| Rate for Payer: Anthem Medicaid |
$5,839.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,244.40
|
| Rate for Payer: Cash Price |
$8,490.00
|
| Rate for Payer: Cigna Commercial |
$14,093.40
|
| Rate for Payer: First Health Commercial |
$16,131.00
|
| Rate for Payer: Humana Commercial |
$14,433.00
|
| Rate for Payer: Humana KY Medicaid |
$5,839.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,898.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,923.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,531.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,094.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,956.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,772.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,716.20
|
| Rate for Payer: PHCS Commercial |
$16,300.80
|
| Rate for Payer: United Healthcare All Payer |
$14,942.40
|
|
|
FEMUR PSN CR CMT NAR SZ 7 L
|
Facility
|
IP
|
$16,980.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,094.00 |
| Max. Negotiated Rate |
$16,300.80 |
| Rate for Payer: Aetna Commercial |
$13,074.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,244.40
|
| Rate for Payer: Cash Price |
$8,490.00
|
| Rate for Payer: Cigna Commercial |
$14,093.40
|
| Rate for Payer: First Health Commercial |
$16,131.00
|
| Rate for Payer: Humana Commercial |
$14,433.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,923.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,531.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,094.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,772.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,716.20
|
| Rate for Payer: PHCS Commercial |
$16,300.80
|
| Rate for Payer: United Healthcare All Payer |
$14,942.40
|
|
|
FEMUR PSN CR CMT NAR SZ 7 R
|
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
|
|
|
FEMUR PSN CR CMT NAR SZ 7 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 8 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
|
|
|
FEMUR PSN CR CMT NAR SZ 8 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 8 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FEMUR PSN CR CMT NAR SZ 8 R
|
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
|
|
