|
MOD ROTATING HINGE KNEE AXLE
|
Facility
|
OP
|
$7,448.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,234.48 |
| Max. Negotiated Rate |
$7,150.33 |
| Rate for Payer: Aetna Commercial |
$5,735.16
|
| Rate for Payer: Anthem Medicaid |
$2,561.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.64
|
| Rate for Payer: Cash Price |
$3,724.13
|
| Rate for Payer: Cigna Commercial |
$6,182.06
|
| Rate for Payer: First Health Commercial |
$7,075.85
|
| Rate for Payer: Humana Commercial |
$6,331.02
|
| Rate for Payer: Humana KY Medicaid |
$2,561.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,587.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,496.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,958.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,479.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,139.30
|
| Rate for Payer: PHCS Commercial |
$7,150.33
|
| Rate for Payer: United Healthcare All Payer |
$6,554.47
|
|
|
MOD ROTATING HINGE KNEE AXLE
|
Facility
|
IP
|
$7,448.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,234.48 |
| Max. Negotiated Rate |
$7,150.33 |
| Rate for Payer: Aetna Commercial |
$5,735.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.64
|
| Rate for Payer: Cash Price |
$3,724.13
|
| Rate for Payer: Cigna Commercial |
$6,182.06
|
| Rate for Payer: First Health Commercial |
$7,075.85
|
| Rate for Payer: Humana Commercial |
$6,331.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,496.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,958.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,479.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,139.30
|
| Rate for Payer: PHCS Commercial |
$7,150.33
|
| Rate for Payer: United Healthcare All Payer |
$6,554.47
|
|
|
MOD ROTATING HINGE KNEE LG LT
|
Facility
|
OP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem Medicaid |
$7,368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Humana KY Medicaid |
$7,368.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,443.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,515.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE LG LT
|
Facility
|
IP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE LG RT
|
Facility
|
OP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem Medicaid |
$7,368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Humana KY Medicaid |
$7,368.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,443.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,515.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE LG RT
|
Facility
|
IP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE MED LT
|
Facility
|
OP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem Medicaid |
$7,368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Humana KY Medicaid |
$7,368.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,443.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,515.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE MED LT
|
Facility
|
IP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE MED RT
|
Facility
|
IP
|
$24,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,202.40 |
| Max. Negotiated Rate |
$23,047.68 |
| Rate for Payer: Aetna Commercial |
$18,486.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,726.24
|
| Rate for Payer: Cash Price |
$12,004.00
|
| Rate for Payer: Cigna Commercial |
$19,926.64
|
| Rate for Payer: First Health Commercial |
$22,807.60
|
| Rate for Payer: Humana Commercial |
$20,406.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,686.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,717.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,202.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,127.04
|
| Rate for Payer: Ohio Health Group HMO |
$18,006.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,206.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,886.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,565.52
|
| Rate for Payer: PHCS Commercial |
$23,047.68
|
| Rate for Payer: United Healthcare All Payer |
$21,127.04
|
|
|
MOD ROTATING HINGE KNEE MED RT
|
Facility
|
OP
|
$24,008.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,202.40 |
| Max. Negotiated Rate |
$23,047.68 |
| Rate for Payer: Aetna Commercial |
$18,486.16
|
| Rate for Payer: Anthem Medicaid |
$8,256.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,726.24
|
| Rate for Payer: Cash Price |
$12,004.00
|
| Rate for Payer: Cigna Commercial |
$19,926.64
|
| Rate for Payer: First Health Commercial |
$22,807.60
|
| Rate for Payer: Humana Commercial |
$20,406.80
|
| Rate for Payer: Humana KY Medicaid |
$8,256.35
|
| Rate for Payer: Kentucky WC Medicaid |
$8,340.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,686.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,717.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,202.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,422.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,127.04
|
| Rate for Payer: Ohio Health Group HMO |
$18,006.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,206.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,886.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,565.52
|
| Rate for Payer: PHCS Commercial |
$23,047.68
|
| Rate for Payer: United Healthcare All Payer |
$21,127.04
|
|
|
MOD ROTATING HINGE KNEE SM LT
|
Facility
|
IP
|
$21,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,532.80 |
| Max. Negotiated Rate |
$20,904.96 |
| Rate for Payer: Aetna Commercial |
$16,767.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,985.28
|
| Rate for Payer: Cash Price |
$10,888.00
|
| Rate for Payer: Cigna Commercial |
$18,074.08
|
| Rate for Payer: First Health Commercial |
$20,687.20
|
| Rate for Payer: Humana Commercial |
$18,509.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,856.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,070.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,532.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,162.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,025.44
|
| Rate for Payer: PHCS Commercial |
$20,904.96
|
| Rate for Payer: United Healthcare All Payer |
$19,162.88
|
|
|
MOD ROTATING HINGE KNEE SM LT
|
Facility
|
OP
|
$21,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,532.80 |
| Max. Negotiated Rate |
$20,904.96 |
| Rate for Payer: Aetna Commercial |
$16,767.52
|
| Rate for Payer: Anthem Medicaid |
$7,488.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,985.28
|
| Rate for Payer: Cash Price |
$10,888.00
|
| Rate for Payer: Cigna Commercial |
$18,074.08
|
| Rate for Payer: First Health Commercial |
$20,687.20
|
| Rate for Payer: Humana Commercial |
$18,509.60
|
| Rate for Payer: Humana KY Medicaid |
$7,488.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,564.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,856.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,070.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,532.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,639.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,162.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,025.44
|
| Rate for Payer: PHCS Commercial |
$20,904.96
|
| Rate for Payer: United Healthcare All Payer |
$19,162.88
|
|
|
MOD ROTATING HINGE KNEE SM RGT
|
Facility
|
OP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,148.50 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem Medicaid |
$7,048.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Humana KY Medicaid |
$7,048.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,119.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,830.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,141.55
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
MOD ROTATING HINGE KNEE SM RGT
|
Facility
|
IP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,148.50 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,830.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,141.55
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
MOD ROTATING HINGE KNEE XL LT
|
Facility
|
OP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem Medicaid |
$7,368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Humana KY Medicaid |
$7,368.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,443.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,515.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE XL LT
|
Facility
|
IP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE XL RT
|
Facility
|
OP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem Medicaid |
$7,368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Humana KY Medicaid |
$7,368.06
|
| Rate for Payer: Kentucky WC Medicaid |
$7,443.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,515.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE XL RT
|
Facility
|
IP
|
$21,425.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,427.50 |
| Max. Negotiated Rate |
$20,568.00 |
| Rate for Payer: Aetna Commercial |
$16,497.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,711.50
|
| Rate for Payer: Cash Price |
$10,712.50
|
| Rate for Payer: Cigna Commercial |
$17,782.75
|
| Rate for Payer: First Health Commercial |
$20,353.75
|
| Rate for Payer: Humana Commercial |
$18,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,568.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,811.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,854.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,639.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,783.25
|
| Rate for Payer: PHCS Commercial |
$20,568.00
|
| Rate for Payer: United Healthcare All Payer |
$18,854.00
|
|
|
MOD ROTATING HINGE KNEE XS LT
|
Facility
|
IP
|
$21,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,532.80 |
| Max. Negotiated Rate |
$20,904.96 |
| Rate for Payer: Aetna Commercial |
$16,767.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,985.28
|
| Rate for Payer: Cash Price |
$10,888.00
|
| Rate for Payer: Cigna Commercial |
$18,074.08
|
| Rate for Payer: First Health Commercial |
$20,687.20
|
| Rate for Payer: Humana Commercial |
$18,509.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,856.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,070.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,532.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,162.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,025.44
|
| Rate for Payer: PHCS Commercial |
$20,904.96
|
| Rate for Payer: United Healthcare All Payer |
$19,162.88
|
|
|
MOD ROTATING HINGE KNEE XS LT
|
Facility
|
OP
|
$21,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,532.80 |
| Max. Negotiated Rate |
$20,904.96 |
| Rate for Payer: Aetna Commercial |
$16,767.52
|
| Rate for Payer: Anthem Medicaid |
$7,488.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,985.28
|
| Rate for Payer: Cash Price |
$10,888.00
|
| Rate for Payer: Cigna Commercial |
$18,074.08
|
| Rate for Payer: First Health Commercial |
$20,687.20
|
| Rate for Payer: Humana Commercial |
$18,509.60
|
| Rate for Payer: Humana KY Medicaid |
$7,488.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,564.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,856.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,070.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,532.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,639.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,162.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,025.44
|
| Rate for Payer: PHCS Commercial |
$20,904.96
|
| Rate for Payer: United Healthcare All Payer |
$19,162.88
|
|
|
MOD ROTATING HINGE KNEE XS RT
|
Facility
|
OP
|
$21,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,532.80 |
| Max. Negotiated Rate |
$20,904.96 |
| Rate for Payer: Aetna Commercial |
$16,767.52
|
| Rate for Payer: Anthem Medicaid |
$7,488.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,985.28
|
| Rate for Payer: Cash Price |
$10,888.00
|
| Rate for Payer: Cigna Commercial |
$18,074.08
|
| Rate for Payer: First Health Commercial |
$20,687.20
|
| Rate for Payer: Humana Commercial |
$18,509.60
|
| Rate for Payer: Humana KY Medicaid |
$7,488.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,564.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,856.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,070.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,532.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,639.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,162.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,025.44
|
| Rate for Payer: PHCS Commercial |
$20,904.96
|
| Rate for Payer: United Healthcare All Payer |
$19,162.88
|
|
|
MOD ROTATING HINGE KNEE XS RT
|
Facility
|
IP
|
$21,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,532.80 |
| Max. Negotiated Rate |
$20,904.96 |
| Rate for Payer: Aetna Commercial |
$16,767.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,985.28
|
| Rate for Payer: Cash Price |
$10,888.00
|
| Rate for Payer: Cigna Commercial |
$18,074.08
|
| Rate for Payer: First Health Commercial |
$20,687.20
|
| Rate for Payer: Humana Commercial |
$18,509.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,856.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,070.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,532.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,162.88
|
| Rate for Payer: Ohio Health Group HMO |
$16,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,025.44
|
| Rate for Payer: PHCS Commercial |
$20,904.96
|
| Rate for Payer: United Healthcare All Payer |
$19,162.88
|
|
|
MOD ROT HINGE KNEE FEM 10MM SM
|
Facility
|
IP
|
$4,211.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.30 |
| Max. Negotiated Rate |
$4,042.56 |
| Rate for Payer: Aetna Commercial |
$3,242.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,284.58
|
| Rate for Payer: Cash Price |
$2,105.50
|
| Rate for Payer: Cigna Commercial |
$3,495.13
|
| Rate for Payer: First Health Commercial |
$4,000.45
|
| Rate for Payer: Humana Commercial |
$3,579.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,453.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,107.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,705.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,158.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,663.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,905.59
|
| Rate for Payer: PHCS Commercial |
$4,042.56
|
| Rate for Payer: United Healthcare All Payer |
$3,705.68
|
|
|
MOD ROT HINGE KNEE FEM 10MM SM
|
Facility
|
OP
|
$4,211.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.30 |
| Max. Negotiated Rate |
$4,042.56 |
| Rate for Payer: Aetna Commercial |
$3,242.47
|
| Rate for Payer: Anthem Medicaid |
$1,448.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,284.58
|
| Rate for Payer: Cash Price |
$2,105.50
|
| Rate for Payer: Cigna Commercial |
$3,495.13
|
| Rate for Payer: First Health Commercial |
$4,000.45
|
| Rate for Payer: Humana Commercial |
$3,579.35
|
| Rate for Payer: Humana KY Medicaid |
$1,448.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,462.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,453.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,107.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,705.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,158.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,663.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,905.59
|
| Rate for Payer: PHCS Commercial |
$4,042.56
|
| Rate for Payer: United Healthcare All Payer |
$3,705.68
|
|
|
MOD ROT HINGE KNEE FEM 10MM XL
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem Medicaid |
$1,493.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Humana KY Medicaid |
$1,493.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
