|
NEXGEN RH KNEE TIB AGMT10M SZ4
|
Facility
|
IP
|
$21,261.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,378.53 |
| Max. Negotiated Rate |
$20,411.29 |
| Rate for Payer: Aetna Commercial |
$16,371.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,584.17
|
| Rate for Payer: Cash Price |
$10,630.88
|
| Rate for Payer: Cigna Commercial |
$17,647.26
|
| Rate for Payer: First Health Commercial |
$20,198.67
|
| Rate for Payer: Humana Commercial |
$18,072.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,434.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,691.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,378.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,710.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,946.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,009.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,497.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,670.61
|
| Rate for Payer: PHCS Commercial |
$20,411.29
|
| Rate for Payer: United Healthcare All Payer |
$18,710.35
|
|
|
NEXGEN RH KNEE TIB AGMT10M SZ4
|
Facility
|
OP
|
$21,261.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,378.53 |
| Max. Negotiated Rate |
$20,411.29 |
| Rate for Payer: Aetna Commercial |
$16,371.56
|
| Rate for Payer: Anthem Medicaid |
$7,311.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,584.17
|
| Rate for Payer: Cash Price |
$10,630.88
|
| Rate for Payer: Cigna Commercial |
$17,647.26
|
| Rate for Payer: First Health Commercial |
$20,198.67
|
| Rate for Payer: Humana Commercial |
$18,072.50
|
| Rate for Payer: Humana KY Medicaid |
$7,311.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,386.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,434.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,691.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,378.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,458.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,710.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,946.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,009.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,497.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,670.61
|
| Rate for Payer: PHCS Commercial |
$20,411.29
|
| Rate for Payer: United Healthcare All Payer |
$18,710.35
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ2
|
Facility
|
IP
|
$3,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.00 |
| Max. Negotiated Rate |
$3,014.40 |
| Rate for Payer: Aetna Commercial |
$2,417.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,449.20
|
| Rate for Payer: Cash Price |
$1,570.00
|
| Rate for Payer: Cigna Commercial |
$2,606.20
|
| Rate for Payer: First Health Commercial |
$2,983.00
|
| Rate for Payer: Humana Commercial |
$2,669.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,574.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,317.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,763.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,355.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.60
|
| Rate for Payer: PHCS Commercial |
$3,014.40
|
| Rate for Payer: United Healthcare All Payer |
$2,763.20
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ2
|
Facility
|
OP
|
$3,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.00 |
| Max. Negotiated Rate |
$3,014.40 |
| Rate for Payer: Aetna Commercial |
$2,417.80
|
| Rate for Payer: Anthem Medicaid |
$1,079.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,449.20
|
| Rate for Payer: Cash Price |
$1,570.00
|
| Rate for Payer: Cigna Commercial |
$2,606.20
|
| Rate for Payer: First Health Commercial |
$2,983.00
|
| Rate for Payer: Humana Commercial |
$2,669.00
|
| Rate for Payer: Humana KY Medicaid |
$1,079.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,090.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,574.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,317.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,101.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,763.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,355.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,731.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,166.60
|
| Rate for Payer: PHCS Commercial |
$3,014.40
|
| Rate for Payer: United Healthcare All Payer |
$2,763.20
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ3
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ3
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ4
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ4
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ6
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ6
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.00 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,436.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,725.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ1
|
Facility
|
OP
|
$3,920.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.00 |
| Max. Negotiated Rate |
$3,763.20 |
| Rate for Payer: Aetna Commercial |
$3,018.40
|
| Rate for Payer: Anthem Medicaid |
$1,348.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,057.60
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cigna Commercial |
$3,253.60
|
| Rate for Payer: First Health Commercial |
$3,724.00
|
| Rate for Payer: Humana Commercial |
$3,332.00
|
| Rate for Payer: Humana KY Medicaid |
$1,348.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,361.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,214.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,449.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,410.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,704.80
|
| Rate for Payer: PHCS Commercial |
$3,763.20
|
| Rate for Payer: United Healthcare All Payer |
$3,449.60
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ1
|
Facility
|
IP
|
$3,920.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.00 |
| Max. Negotiated Rate |
$3,763.20 |
| Rate for Payer: Aetna Commercial |
$3,018.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,057.60
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cigna Commercial |
$3,253.60
|
| Rate for Payer: First Health Commercial |
$3,724.00
|
| Rate for Payer: Humana Commercial |
$3,332.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,214.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,449.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,410.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,704.80
|
| Rate for Payer: PHCS Commercial |
$3,763.20
|
| Rate for Payer: United Healthcare All Payer |
$3,449.60
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ2
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ2
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ3
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
NEXGEN RH KNEE TIB PLAT NM SZ3
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
NEXGEN RH KNE FEM MOD BX SZ C
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ C
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ D
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ D
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ E
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ E
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ F
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE FEM MOD BX SZ F
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
NEXGEN RH KNE TIB AGMT 10M SZ2
|
Facility
|
OP
|
$21,261.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,378.53 |
| Max. Negotiated Rate |
$20,411.29 |
| Rate for Payer: Aetna Commercial |
$16,371.56
|
| Rate for Payer: Anthem Medicaid |
$7,311.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,584.17
|
| Rate for Payer: Cash Price |
$10,630.88
|
| Rate for Payer: Cigna Commercial |
$17,647.26
|
| Rate for Payer: First Health Commercial |
$20,198.67
|
| Rate for Payer: Humana Commercial |
$18,072.50
|
| Rate for Payer: Humana KY Medicaid |
$7,311.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,386.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,434.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,691.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,378.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,458.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,710.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,946.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,009.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,497.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,670.61
|
| Rate for Payer: PHCS Commercial |
$20,411.29
|
| Rate for Payer: United Healthcare All Payer |
$18,710.35
|
|
