|
NEXGEN MTL AUG BLK POS SZD 5M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZD 5M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZE 10M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZE 10M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZE 5M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZE 5M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZF 10M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZF 10M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZF 5M
|
Facility
|
OP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem Medicaid |
$3,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Humana KY Medicaid |
$3,979.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,059.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN MTL AUG BLK POS SZF 5M
|
Facility
|
IP
|
$11,572.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,471.64 |
| Max. Negotiated Rate |
$11,109.24 |
| Rate for Payer: Aetna Commercial |
$8,910.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,026.26
|
| Rate for Payer: Cash Price |
$5,786.06
|
| Rate for Payer: Cigna Commercial |
$9,604.87
|
| Rate for Payer: First Health Commercial |
$10,993.52
|
| Rate for Payer: Humana Commercial |
$9,836.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,489.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,540.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,183.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,679.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,257.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,067.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,984.77
|
| Rate for Payer: PHCS Commercial |
$11,109.24
|
| Rate for Payer: United Healthcare All Payer |
$10,183.47
|
|
|
NEXGEN POROUS TM PATELLA 10*32
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*32
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*35
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*35
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*38
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*38
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*41
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POROUS TM PATELLA 10*41
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
NEXGEN POST FEM AUG 5MM SZ B
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| 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: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| 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: Molina Healthcare Medicaid |
$8.07
|
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN POST FEM AUG 5MM SZ B
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN POST FEM AUG 5MM SZ C/D
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| 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: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| 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: Molina Healthcare Medicaid |
$8.07
|
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN POST FEM AUG 5MM SZ C/D
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN POST FEM AUG 5MM SZ E/F
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| 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: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| 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: Molina Healthcare Medicaid |
$8.07
|
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN POST FEM AUG 5MM SZ E/F
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN POST FEM AUG 5MM SZ G
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| 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: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| 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: Molina Healthcare Medicaid |
$8.07
|
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
