|
FEMUR PSN MCVE ASF R 13M 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 13M 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 13M 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 13M 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 14M 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 14M 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 14M 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 14M 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 16M 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 16M 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 16M 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 16M 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 18M 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 18M 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 18M 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 18M 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 20M 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MCVE ASF R 20M 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 20M 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR PSN MC VE ASF R 20M 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMUR RESURFACING AXIAL PIN 2
|
Facility
|
IP
|
$17,298.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.46 |
| Max. Negotiated Rate |
$16,606.27 |
| Rate for Payer: Aetna Commercial |
$13,319.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,492.60
|
| Rate for Payer: Cash Price |
$8,649.10
|
| Rate for Payer: Cigna Commercial |
$14,357.51
|
| Rate for Payer: First Health Commercial |
$16,433.29
|
| Rate for Payer: Humana Commercial |
$14,703.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,184.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,189.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,222.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,973.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,838.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,049.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,935.76
|
| Rate for Payer: PHCS Commercial |
$16,606.27
|
| Rate for Payer: United Healthcare All Payer |
$15,222.42
|
|
|
FEMUR RESURFACING AXIAL PIN 2
|
Facility
|
OP
|
$17,298.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.46 |
| Max. Negotiated Rate |
$16,606.27 |
| Rate for Payer: Aetna Commercial |
$13,319.61
|
| Rate for Payer: Anthem Medicaid |
$5,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,492.60
|
| Rate for Payer: Cash Price |
$8,649.10
|
| Rate for Payer: Cigna Commercial |
$14,357.51
|
| Rate for Payer: First Health Commercial |
$16,433.29
|
| Rate for Payer: Humana Commercial |
$14,703.47
|
| Rate for Payer: Humana KY Medicaid |
$5,948.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,009.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,184.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,189.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,068.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,222.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,973.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,838.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,049.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,935.76
|
| Rate for Payer: PHCS Commercial |
$16,606.27
|
| Rate for Payer: United Healthcare All Payer |
$15,222.42
|
|
|
FEMUR RESURFACING AXIAL PIN SZ
|
Facility
|
OP
|
$17,298.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.46 |
| Max. Negotiated Rate |
$16,606.27 |
| Rate for Payer: Aetna Commercial |
$13,319.61
|
| Rate for Payer: Anthem Medicaid |
$5,948.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,492.60
|
| Rate for Payer: Cash Price |
$8,649.10
|
| Rate for Payer: Cigna Commercial |
$14,357.51
|
| Rate for Payer: First Health Commercial |
$16,433.29
|
| Rate for Payer: Humana Commercial |
$14,703.47
|
| Rate for Payer: Humana KY Medicaid |
$5,948.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,009.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,184.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,189.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,068.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,222.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,973.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,838.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,049.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,935.76
|
| Rate for Payer: PHCS Commercial |
$16,606.27
|
| Rate for Payer: United Healthcare All Payer |
$15,222.42
|
|
|
FEMUR RESURFACING AXIAL PIN SZ
|
Facility
|
IP
|
$17,298.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,189.46 |
| Max. Negotiated Rate |
$16,606.27 |
| Rate for Payer: Aetna Commercial |
$13,319.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,492.60
|
| Rate for Payer: Cash Price |
$8,649.10
|
| Rate for Payer: Cigna Commercial |
$14,357.51
|
| Rate for Payer: First Health Commercial |
$16,433.29
|
| Rate for Payer: Humana Commercial |
$14,703.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,184.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,189.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,222.42
|
| Rate for Payer: Ohio Health Group HMO |
$12,973.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,838.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,049.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,935.76
|
| Rate for Payer: PHCS Commercial |
$16,606.27
|
| Rate for Payer: United Healthcare All Payer |
$15,222.42
|
|
|
FEMUR RESURFACING AX PIN SZ 1
|
Facility
|
IP
|
$13,720.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,116.28 |
| Max. Negotiated Rate |
$13,172.11 |
| Rate for Payer: Aetna Commercial |
$10,565.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,702.34
|
| Rate for Payer: Cash Price |
$6,860.48
|
| Rate for Payer: Cigna Commercial |
$11,388.39
|
| Rate for Payer: First Health Commercial |
$13,034.90
|
| Rate for Payer: Humana Commercial |
$11,662.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,251.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,126.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,116.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,074.44
|
| Rate for Payer: Ohio Health Group HMO |
$10,290.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,976.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,937.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,467.46
|
| Rate for Payer: PHCS Commercial |
$13,172.11
|
| Rate for Payer: United Healthcare All Payer |
$12,074.44
|
|
