|
NEXGEN RH KNEE TIBIAL PLAT SZ6
|
Facility
|
OP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem Medicaid |
$1,382.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Humana KY Medicaid |
$1,382.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,396.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,410.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ6
|
Facility
|
IP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ1
|
Facility
|
IP
|
$3,992.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.96 |
| Max. Negotiated Rate |
$3,832.32 |
| Rate for Payer: Aetna Commercial |
$3,073.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,113.76
|
| Rate for Payer: Cash Price |
$1,996.00
|
| Rate for Payer: Cigna Commercial |
$3,313.36
|
| Rate for Payer: First Health Commercial |
$3,792.40
|
| Rate for Payer: Humana Commercial |
$3,393.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,273.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,946.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,512.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,994.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.52
|
| Rate for Payer: PHCS Commercial |
$3,832.32
|
| Rate for Payer: United Healthcare All Payer |
$3,512.96
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ1
|
Facility
|
OP
|
$3,992.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.96 |
| Max. Negotiated Rate |
$3,832.32 |
| Rate for Payer: Aetna Commercial |
$3,073.84
|
| Rate for Payer: Anthem Medicaid |
$1,372.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,113.76
|
| Rate for Payer: Cash Price |
$1,996.00
|
| Rate for Payer: Cigna Commercial |
$3,313.36
|
| Rate for Payer: First Health Commercial |
$3,792.40
|
| Rate for Payer: Humana Commercial |
$3,393.20
|
| Rate for Payer: Humana KY Medicaid |
$1,372.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,386.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,273.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,946.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,400.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,512.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,994.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.52
|
| Rate for Payer: PHCS Commercial |
$3,832.32
|
| Rate for Payer: United Healthcare All Payer |
$3,512.96
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ2
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ2
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ3
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ3
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
NEXGEN RH KNE FEM MOD BX SZ C
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ C
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ D
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ D
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ E
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ E
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ F
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ F
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ2
|
Facility
|
IP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ2
|
Facility
|
OP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem Medicaid |
$7,094.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Humana KY Medicaid |
$7,094.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,166.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,236.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ3
|
Facility
|
OP
|
$20,591.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.91 |
| Max. Negotiated Rate |
$19,767.96 |
| Rate for Payer: Aetna Commercial |
$15,855.55
|
| Rate for Payer: Anthem Medicaid |
$7,081.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,061.46
|
| Rate for Payer: Cash Price |
$10,295.81
|
| Rate for Payer: Cigna Commercial |
$17,091.04
|
| Rate for Payer: First Health Commercial |
$19,562.04
|
| Rate for Payer: Humana Commercial |
$17,502.88
|
| Rate for Payer: Humana KY Medicaid |
$7,081.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,153.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,885.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,196.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,177.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,223.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,120.63
|
| Rate for Payer: Ohio Health Group HMO |
$15,443.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,118.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,383.40
|
| Rate for Payer: PHCS Commercial |
$19,767.96
|
| Rate for Payer: United Healthcare All Payer |
$18,120.63
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ3
|
Facility
|
IP
|
$20,591.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,676.91 |
| Max. Negotiated Rate |
$19,767.96 |
| Rate for Payer: Aetna Commercial |
$15,855.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,061.46
|
| Rate for Payer: Cash Price |
$10,295.81
|
| Rate for Payer: Cigna Commercial |
$17,091.04
|
| Rate for Payer: First Health Commercial |
$19,562.04
|
| Rate for Payer: Humana Commercial |
$17,502.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,885.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,196.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,177.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,120.63
|
| Rate for Payer: Ohio Health Group HMO |
$15,443.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,118.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,383.40
|
| Rate for Payer: PHCS Commercial |
$19,767.96
|
| Rate for Payer: United Healthcare All Payer |
$18,120.63
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ4
|
Facility
|
OP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem Medicaid |
$7,094.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Humana KY Medicaid |
$7,094.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,166.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,236.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ4
|
Facility
|
IP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ6
|
Facility
|
IP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ6
|
Facility
|
OP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem Medicaid |
$7,094.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Humana KY Medicaid |
$7,094.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,166.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,236.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN TAPER PLUG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
