|
LINER G7 DUAL MOBILITY 32MM A
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 36MM B
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 36MM B
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 38MM C
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 38MM C
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 40MM D
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 40MM D
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 44MM F
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 44MM F
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 46MM G
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 46MM G
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 50MM H
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 50MM H
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 54MM I
|
Facility
|
IP
|
$24,939.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,481.85 |
| Max. Negotiated Rate |
$23,941.92 |
| Rate for Payer: Aetna Commercial |
$19,203.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,452.81
|
| Rate for Payer: Cash Price |
$12,469.75
|
| Rate for Payer: Cigna Commercial |
$20,699.78
|
| Rate for Payer: First Health Commercial |
$23,692.53
|
| Rate for Payer: Humana Commercial |
$21,198.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,450.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,405.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,481.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,946.76
|
| Rate for Payer: Ohio Health Group HMO |
$18,704.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,951.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,697.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,208.26
|
| Rate for Payer: PHCS Commercial |
$23,941.92
|
| Rate for Payer: United Healthcare All Payer |
$21,946.76
|
|
|
LINER G7 DUAL MOBILITY 54MM I
|
Facility
|
OP
|
$24,939.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,481.85 |
| Max. Negotiated Rate |
$23,941.92 |
| Rate for Payer: Aetna Commercial |
$19,203.42
|
| Rate for Payer: Anthem Medicaid |
$8,576.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,452.81
|
| Rate for Payer: Cash Price |
$12,469.75
|
| Rate for Payer: Cigna Commercial |
$20,699.78
|
| Rate for Payer: First Health Commercial |
$23,692.53
|
| Rate for Payer: Humana Commercial |
$21,198.58
|
| Rate for Payer: Humana KY Medicaid |
$8,576.69
|
| Rate for Payer: Kentucky WC Medicaid |
$8,663.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,450.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,405.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,481.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,748.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,946.76
|
| Rate for Payer: Ohio Health Group HMO |
$18,704.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,951.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,697.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,208.26
|
| Rate for Payer: PHCS Commercial |
$23,941.92
|
| Rate for Payer: United Healthcare All Payer |
$21,946.76
|
|
|
LINER G7 DUAL MOBILITY 60MM J
|
Facility
|
IP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 DUAL MOBILITY 60MM J
|
Facility
|
OP
|
$9,789.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,936.70 |
| Max. Negotiated Rate |
$9,397.44 |
| Rate for Payer: Aetna Commercial |
$7,537.53
|
| Rate for Payer: Anthem Medicaid |
$3,366.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,635.42
|
| Rate for Payer: Cash Price |
$4,894.50
|
| Rate for Payer: Cigna Commercial |
$8,124.87
|
| Rate for Payer: First Health Commercial |
$9,299.55
|
| Rate for Payer: Humana Commercial |
$8,320.65
|
| Rate for Payer: Humana KY Medicaid |
$3,366.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,400.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,026.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,224.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,936.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,614.32
|
| Rate for Payer: Ohio Health Group HMO |
$7,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,516.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,754.41
|
| Rate for Payer: PHCS Commercial |
$9,397.44
|
| Rate for Payer: United Healthcare All Payer |
$8,614.32
|
|
|
LINER G7 FREEDOM CONST 10^ 32B
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 32B
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 32C
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 32C
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36D
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36D
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36E
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36E
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
