|
LINER G7 ACETABULAR 44 H
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 ACETABULAR 44 I
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 ACETABULAR 44 I
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 ACETABULAR 44 J
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 ACETABULAR 44 J
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 ARCOMXL 32MM H
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 ARCOMXL 32MM H
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINER G7 DUAL MOBILITY 32MM A
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 32MM A
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 36MM B
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 36MM B
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 38MM C
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 38MM C
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 40MM D
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 40MM D
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 44MM F
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 44MM F
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 46MM G
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 46MM G
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 50MM H
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 50MM H
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 54MM I
|
Facility
|
IP
|
$24,207.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.01 |
| Max. Negotiated Rate |
$23,239.47 |
| Rate for Payer: Aetna Commercial |
$18,639.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,882.07
|
| Rate for Payer: Cash Price |
$12,103.89
|
| Rate for Payer: Cigna Commercial |
$20,092.46
|
| Rate for Payer: First Health Commercial |
$22,997.39
|
| Rate for Payer: Humana Commercial |
$20,576.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,850.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,865.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,262.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,302.85
|
| Rate for Payer: Ohio Health Group HMO |
$18,155.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,841.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,147.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,504.41
|
| Rate for Payer: PHCS Commercial |
$23,239.47
|
| Rate for Payer: United Healthcare All Payer |
$21,302.85
|
|
|
LINER G7 DUAL MOBILITY 54MM I
|
Facility
|
OP
|
$24,207.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,147.01 |
| Max. Negotiated Rate |
$23,239.47 |
| Rate for Payer: Aetna Commercial |
$18,639.99
|
| Rate for Payer: Anthem Medicaid |
$8,325.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,882.07
|
| Rate for Payer: Cash Price |
$12,103.89
|
| Rate for Payer: Cigna Commercial |
$20,092.46
|
| Rate for Payer: First Health Commercial |
$22,997.39
|
| Rate for Payer: Humana Commercial |
$20,576.61
|
| Rate for Payer: Humana KY Medicaid |
$8,325.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,409.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,850.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,865.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,262.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,492.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,302.85
|
| Rate for Payer: Ohio Health Group HMO |
$18,155.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,841.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,147.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,504.41
|
| Rate for Payer: PHCS Commercial |
$23,239.47
|
| Rate for Payer: United Healthcare All Payer |
$21,302.85
|
|
|
LINER G7 DUAL MOBILITY 60MM J
|
Facility
|
IP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
|
LINER G7 DUAL MOBILITY 60MM J
|
Facility
|
OP
|
$9,589.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.57 |
| Max. Negotiated Rate |
$9,205.44 |
| Rate for Payer: Aetna Commercial |
$7,383.53
|
| Rate for Payer: Anthem Medicaid |
$3,297.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,479.42
|
| Rate for Payer: Cash Price |
$4,794.50
|
| Rate for Payer: Cigna Commercial |
$7,958.87
|
| Rate for Payer: First Health Commercial |
$9,109.55
|
| Rate for Payer: Humana Commercial |
$8,150.65
|
| Rate for Payer: Humana KY Medicaid |
$3,297.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,331.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,438.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,917.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,246.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,972.59
|
| Rate for Payer: PHCS Commercial |
$9,205.44
|
| Rate for Payer: United Healthcare All Payer |
$8,438.32
|
|
