|
MOD ROTATING HINGE KNEE LG RT
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE MED LT
|
Facility
|
OP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem Medicaid |
$7,148.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Humana KY Medicaid |
$7,148.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,221.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,292.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE MED LT
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE MED RT
|
Facility
|
OP
|
$23,301.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.15 |
| Max. Negotiated Rate |
$22,369.08 |
| Rate for Payer: Aetna Commercial |
$17,941.86
|
| Rate for Payer: Anthem Medicaid |
$8,013.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,174.87
|
| Rate for Payer: Cash Price |
$11,650.56
|
| Rate for Payer: Cigna Commercial |
$19,339.93
|
| Rate for Payer: First Health Commercial |
$22,136.06
|
| Rate for Payer: Humana Commercial |
$19,805.95
|
| Rate for Payer: Humana KY Medicaid |
$8,013.26
|
| Rate for Payer: Kentucky WC Medicaid |
$8,094.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,106.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,196.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,990.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,174.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,504.99
|
| Rate for Payer: Ohio Health Group HMO |
$17,475.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,660.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,029.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,223.35
|
| Rate for Payer: PHCS Commercial |
$22,369.08
|
| Rate for Payer: United Healthcare All Payer |
$20,504.99
|
|
|
MOD ROTATING HINGE KNEE MED RT
|
Facility
|
IP
|
$23,301.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.15 |
| Max. Negotiated Rate |
$22,369.08 |
| Rate for Payer: Aetna Commercial |
$17,941.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,174.87
|
| Rate for Payer: Cash Price |
$11,650.56
|
| Rate for Payer: Cigna Commercial |
$19,339.93
|
| Rate for Payer: First Health Commercial |
$22,136.06
|
| Rate for Payer: Humana Commercial |
$19,805.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,106.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,196.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,990.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,504.99
|
| Rate for Payer: Ohio Health Group HMO |
$17,475.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,660.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,029.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,223.35
|
| Rate for Payer: PHCS Commercial |
$22,369.08
|
| Rate for Payer: United Healthcare All Payer |
$20,504.99
|
|
|
MOD ROTATING HINGE KNEE SM LT
|
Facility
|
IP
|
$21,128.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.72 |
| Max. Negotiated Rate |
$20,283.49 |
| Rate for Payer: Aetna Commercial |
$16,269.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,480.34
|
| Rate for Payer: Cash Price |
$10,564.32
|
| Rate for Payer: Cigna Commercial |
$17,536.77
|
| Rate for Payer: First Health Commercial |
$20,072.21
|
| Rate for Payer: Humana Commercial |
$17,959.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,592.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,338.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,593.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,846.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,549.88
|
| Rate for Payer: PHCS Commercial |
$20,283.49
|
| Rate for Payer: United Healthcare All Payer |
$18,593.20
|
|
|
MOD ROTATING HINGE KNEE SM LT
|
Facility
|
OP
|
$21,128.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.72 |
| Max. Negotiated Rate |
$20,283.49 |
| Rate for Payer: Aetna Commercial |
$16,269.05
|
| Rate for Payer: Anthem Medicaid |
$7,266.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,480.34
|
| Rate for Payer: Cash Price |
$10,564.32
|
| Rate for Payer: Cigna Commercial |
$17,536.77
|
| Rate for Payer: First Health Commercial |
$20,072.21
|
| Rate for Payer: Humana Commercial |
$17,959.34
|
| Rate for Payer: Humana KY Medicaid |
$7,266.14
|
| Rate for Payer: Kentucky WC Medicaid |
$7,340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,592.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,338.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,411.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,593.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,846.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,549.88
|
| Rate for Payer: PHCS Commercial |
$20,283.49
|
| Rate for Payer: United Healthcare All Payer |
$18,593.20
|
|
|
MOD ROTATING HINGE KNEE SM RGT
|
Facility
|
OP
|
$19,881.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.63 |
| Max. Negotiated Rate |
$19,086.53 |
| Rate for Payer: Aetna Commercial |
$15,308.99
|
| Rate for Payer: Anthem Medicaid |
$6,837.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,507.80
|
| Rate for Payer: Cash Price |
$9,940.90
|
| Rate for Payer: Cigna Commercial |
$16,501.89
|
| Rate for Payer: First Health Commercial |
$18,887.71
|
| Rate for Payer: Humana Commercial |
$16,899.53
|
| Rate for Payer: Humana KY Medicaid |
$6,837.35
|
| Rate for Payer: Kentucky WC Medicaid |
$6,906.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,303.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,964.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,974.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,495.98
|
| Rate for Payer: Ohio Health Group HMO |
$14,911.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,976.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,584.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,163.36
|
| Rate for Payer: PHCS Commercial |
$19,086.53
|
| Rate for Payer: United Healthcare All Payer |
$17,495.98
|
|
|
MOD ROTATING HINGE KNEE SM RGT
|
Facility
|
IP
|
$19,881.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.63 |
| Max. Negotiated Rate |
$19,086.53 |
| Rate for Payer: Aetna Commercial |
$15,308.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,507.80
|
| Rate for Payer: Cash Price |
$9,940.90
|
| Rate for Payer: Cigna Commercial |
$16,501.89
|
| Rate for Payer: First Health Commercial |
$18,887.71
|
| Rate for Payer: Humana Commercial |
$16,899.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,303.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,672.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,964.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,495.98
|
| Rate for Payer: Ohio Health Group HMO |
$14,911.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,976.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,584.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,163.36
|
| Rate for Payer: PHCS Commercial |
$19,086.53
|
| Rate for Payer: United Healthcare All Payer |
$17,495.98
|
|
|
MOD ROTATING HINGE KNEE XL LT
|
Facility
|
OP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem Medicaid |
$7,148.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Humana KY Medicaid |
$7,148.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,221.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,292.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE XL LT
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE XL RT
|
Facility
|
IP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE XL RT
|
Facility
|
OP
|
$20,787.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.31 |
| Max. Negotiated Rate |
$19,955.52 |
| Rate for Payer: Aetna Commercial |
$16,005.99
|
| Rate for Payer: Anthem Medicaid |
$7,148.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,213.86
|
| Rate for Payer: Cash Price |
$10,393.50
|
| Rate for Payer: Cigna Commercial |
$17,253.21
|
| Rate for Payer: First Health Commercial |
$19,747.65
|
| Rate for Payer: Humana Commercial |
$17,668.95
|
| Rate for Payer: Humana KY Medicaid |
$7,148.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7,221.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,045.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,340.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,236.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,292.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,292.56
|
| Rate for Payer: Ohio Health Group HMO |
$15,590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,443.97
|
| Rate for Payer: PHCS Commercial |
$19,955.52
|
| Rate for Payer: United Healthcare All Payer |
$18,292.56
|
|
|
MOD ROTATING HINGE KNEE XS LT
|
Facility
|
OP
|
$21,128.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.72 |
| Max. Negotiated Rate |
$20,283.49 |
| Rate for Payer: Aetna Commercial |
$16,269.05
|
| Rate for Payer: Anthem Medicaid |
$7,266.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,480.34
|
| Rate for Payer: Cash Price |
$10,564.32
|
| Rate for Payer: Cigna Commercial |
$17,536.77
|
| Rate for Payer: First Health Commercial |
$20,072.21
|
| Rate for Payer: Humana Commercial |
$17,959.34
|
| Rate for Payer: Humana KY Medicaid |
$7,266.14
|
| Rate for Payer: Kentucky WC Medicaid |
$7,340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,592.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,338.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,411.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,593.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,846.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,549.88
|
| Rate for Payer: PHCS Commercial |
$20,283.49
|
| Rate for Payer: United Healthcare All Payer |
$18,593.20
|
|
|
MOD ROTATING HINGE KNEE XS LT
|
Facility
|
IP
|
$21,128.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.72 |
| Max. Negotiated Rate |
$20,283.49 |
| Rate for Payer: Aetna Commercial |
$16,269.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,480.34
|
| Rate for Payer: Cash Price |
$10,564.32
|
| Rate for Payer: Cigna Commercial |
$17,536.77
|
| Rate for Payer: First Health Commercial |
$20,072.21
|
| Rate for Payer: Humana Commercial |
$17,959.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,592.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,338.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,593.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,846.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,549.88
|
| Rate for Payer: PHCS Commercial |
$20,283.49
|
| Rate for Payer: United Healthcare All Payer |
$18,593.20
|
|
|
MOD ROTATING HINGE KNEE XS RT
|
Facility
|
OP
|
$21,128.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.72 |
| Max. Negotiated Rate |
$20,283.49 |
| Rate for Payer: Aetna Commercial |
$16,269.05
|
| Rate for Payer: Anthem Medicaid |
$7,266.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,480.34
|
| Rate for Payer: Cash Price |
$10,564.32
|
| Rate for Payer: Cigna Commercial |
$17,536.77
|
| Rate for Payer: First Health Commercial |
$20,072.21
|
| Rate for Payer: Humana Commercial |
$17,959.34
|
| Rate for Payer: Humana KY Medicaid |
$7,266.14
|
| Rate for Payer: Kentucky WC Medicaid |
$7,340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,592.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,338.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,411.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,593.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,846.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,549.88
|
| Rate for Payer: PHCS Commercial |
$20,283.49
|
| Rate for Payer: United Healthcare All Payer |
$18,593.20
|
|
|
MOD ROTATING HINGE KNEE XS RT
|
Facility
|
IP
|
$21,128.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.72 |
| Max. Negotiated Rate |
$20,283.49 |
| Rate for Payer: Aetna Commercial |
$16,269.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,480.34
|
| Rate for Payer: Cash Price |
$10,564.32
|
| Rate for Payer: Cigna Commercial |
$17,536.77
|
| Rate for Payer: First Health Commercial |
$20,072.21
|
| Rate for Payer: Humana Commercial |
$17,959.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,325.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,592.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,338.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,593.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,846.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,225.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,746.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,549.88
|
| Rate for Payer: PHCS Commercial |
$20,283.49
|
| Rate for Payer: United Healthcare All Payer |
$18,593.20
|
|
|
MOD ROT HINGE KNEE FEM 10MM SM
|
Facility
|
IP
|
$4,263.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.27 |
| Max. Negotiated Rate |
$4,093.06 |
| Rate for Payer: Aetna Commercial |
$3,282.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.61
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,538.79
|
| Rate for Payer: First Health Commercial |
$4,050.42
|
| Rate for Payer: Humana Commercial |
$3,624.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,751.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,197.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.72
|
| Rate for Payer: PHCS Commercial |
$4,093.06
|
| Rate for Payer: United Healthcare All Payer |
$3,751.97
|
|
|
MOD ROT HINGE KNEE FEM 10MM SM
|
Facility
|
OP
|
$4,263.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.27 |
| Max. Negotiated Rate |
$4,093.06 |
| Rate for Payer: Aetna Commercial |
$3,282.97
|
| Rate for Payer: Anthem Medicaid |
$1,466.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.61
|
| Rate for Payer: Cash Price |
$2,131.80
|
| Rate for Payer: Cigna Commercial |
$3,538.79
|
| Rate for Payer: First Health Commercial |
$4,050.42
|
| Rate for Payer: Humana Commercial |
$3,624.06
|
| Rate for Payer: Humana KY Medicaid |
$1,466.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,481.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,495.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,751.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,197.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.72
|
| Rate for Payer: PHCS Commercial |
$4,093.06
|
| Rate for Payer: United Healthcare All Payer |
$3,751.97
|
|
|
MOD ROT HINGE KNEE FEM 10MM XL
|
Facility
|
IP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD ROT HINGE KNEE FEM 10MM XL
|
Facility
|
OP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem Medicaid |
$1,508.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Humana KY Medicaid |
$1,508.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,523.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,538.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD ROT HINGE KNEE FEM 10MM XS
|
Facility
|
IP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD ROT HINGE KNEE FEM 10MM XS
|
Facility
|
OP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem Medicaid |
$1,508.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Humana KY Medicaid |
$1,508.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,523.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,538.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD ROT HINGE KNE FEM 10MM LRG
|
Facility
|
OP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem Medicaid |
$1,508.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Humana KY Medicaid |
$1,508.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,523.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,538.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD ROT HINGE KNE FEM 10MM LRG
|
Facility
|
IP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
