|
OX PART KNEE TWIN PEG FEM LG
|
Facility
|
IP
|
$12,049.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.38 |
| Max. Negotiated Rate |
$11,567.09 |
| Rate for Payer: Aetna Commercial |
$9,277.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,398.26
|
| Rate for Payer: Cash Price |
$6,024.52
|
| Rate for Payer: Cigna Commercial |
$10,000.71
|
| Rate for Payer: First Health Commercial |
$11,446.60
|
| Rate for Payer: Humana Commercial |
$10,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,880.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,614.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,603.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,036.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.21
|
| Rate for Payer: PHCS Commercial |
$11,567.09
|
| Rate for Payer: United Healthcare All Payer |
$10,603.16
|
|
|
OX PART KNEE TWIN PEG FEM MED
|
Facility
|
OP
|
$12,049.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.38 |
| Max. Negotiated Rate |
$11,567.09 |
| Rate for Payer: Aetna Commercial |
$9,277.77
|
| Rate for Payer: Anthem Medicaid |
$4,143.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,398.26
|
| Rate for Payer: Cash Price |
$6,024.52
|
| Rate for Payer: Cigna Commercial |
$10,000.71
|
| Rate for Payer: First Health Commercial |
$11,446.60
|
| Rate for Payer: Humana Commercial |
$10,241.69
|
| Rate for Payer: Humana KY Medicaid |
$4,143.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,185.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,880.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,614.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,226.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,603.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,036.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.21
|
| Rate for Payer: PHCS Commercial |
$11,567.09
|
| Rate for Payer: United Healthcare All Payer |
$10,603.16
|
|
|
OX PART KNEE TWIN PEG FEM MED
|
Facility
|
IP
|
$12,049.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.38 |
| Max. Negotiated Rate |
$11,567.09 |
| Rate for Payer: Aetna Commercial |
$9,277.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,398.26
|
| Rate for Payer: Cash Price |
$6,024.52
|
| Rate for Payer: Cigna Commercial |
$10,000.71
|
| Rate for Payer: First Health Commercial |
$11,446.60
|
| Rate for Payer: Humana Commercial |
$10,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,880.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,614.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,603.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,036.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.21
|
| Rate for Payer: PHCS Commercial |
$11,567.09
|
| Rate for Payer: United Healthcare All Payer |
$10,603.16
|
|
|
OX PART KNEE TWIN PEG FEM SM
|
Facility
|
OP
|
$12,049.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.38 |
| Max. Negotiated Rate |
$11,567.09 |
| Rate for Payer: Aetna Commercial |
$9,277.77
|
| Rate for Payer: Anthem Medicaid |
$4,143.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,398.26
|
| Rate for Payer: Cash Price |
$6,024.52
|
| Rate for Payer: Cigna Commercial |
$10,000.71
|
| Rate for Payer: First Health Commercial |
$11,446.60
|
| Rate for Payer: Humana Commercial |
$10,241.69
|
| Rate for Payer: Humana KY Medicaid |
$4,143.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,185.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,880.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,614.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,226.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,603.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,036.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.21
|
| Rate for Payer: PHCS Commercial |
$11,567.09
|
| Rate for Payer: United Healthcare All Payer |
$10,603.16
|
|
|
OX PART KNEE TWIN PEG FEM SM
|
Facility
|
IP
|
$12,049.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,566.38 |
| Max. Negotiated Rate |
$11,567.09 |
| Rate for Payer: Aetna Commercial |
$9,277.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,398.26
|
| Rate for Payer: Cash Price |
$6,024.52
|
| Rate for Payer: Cigna Commercial |
$10,000.71
|
| Rate for Payer: First Health Commercial |
$11,446.60
|
| Rate for Payer: Humana Commercial |
$10,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,880.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,614.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,603.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,036.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.21
|
| Rate for Payer: PHCS Commercial |
$11,567.09
|
| Rate for Payer: United Healthcare All Payer |
$10,603.16
|
|
|
OX PART KNEE TWIN PEG FEM X LG
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX PART KNEE TWIN PEG FEM X LG
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX PART KNEE TWIN PEG FEM XS
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX PART KNEE TWIN PEG FEM XS
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX TIB COMP SZ AA LM
|
Facility
|
IP
|
$10,027.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$9,625.92 |
| Rate for Payer: Aetna Commercial |
$7,720.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,821.06
|
| Rate for Payer: Cash Price |
$5,013.50
|
| Rate for Payer: Cigna Commercial |
$8,322.41
|
| Rate for Payer: First Health Commercial |
$9,525.65
|
| Rate for Payer: Humana Commercial |
$8,522.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,222.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,005.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,108.37
|
| Rate for Payer: PHCS Commercial |
$9,625.92
|
| Rate for Payer: United Healthcare All Payer |
$8,823.76
|
|
|
OX TIB COMP SZ AA LM
|
Facility
|
OP
|
$10,027.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$9,625.92 |
| Rate for Payer: Aetna Commercial |
$7,720.79
|
| Rate for Payer: Anthem Medicaid |
$3,448.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,821.06
|
| Rate for Payer: Cash Price |
$5,013.50
|
| Rate for Payer: Cigna Commercial |
$8,322.41
|
| Rate for Payer: First Health Commercial |
$9,525.65
|
| Rate for Payer: Humana Commercial |
$8,522.95
|
| Rate for Payer: Humana KY Medicaid |
$3,448.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,222.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,005.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,108.37
|
| Rate for Payer: PHCS Commercial |
$9,625.92
|
| Rate for Payer: United Healthcare All Payer |
$8,823.76
|
|
|
OX TIB COMP SZ B RM
|
Facility
|
OP
|
$8,942.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.58 |
| Max. Negotiated Rate |
$8,585.23 |
| Rate for Payer: Aetna Commercial |
$6,886.07
|
| Rate for Payer: Anthem Medicaid |
$3,075.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,975.50
|
| Rate for Payer: Cash Price |
$4,471.48
|
| Rate for Payer: Cigna Commercial |
$7,422.65
|
| Rate for Payer: First Health Commercial |
$8,495.80
|
| Rate for Payer: Humana Commercial |
$7,601.51
|
| Rate for Payer: Humana KY Medicaid |
$3,075.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,333.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,599.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,137.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,869.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,707.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,788.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,162.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,772.31
|
| Rate for Payer: PHCS Commercial |
$8,585.23
|
| Rate for Payer: United Healthcare All Payer |
$7,869.80
|
|
|
OX TIB COMP SZ B RM
|
Facility
|
IP
|
$8,942.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.58 |
| Max. Negotiated Rate |
$8,585.23 |
| Rate for Payer: Aetna Commercial |
$6,886.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,975.50
|
| Rate for Payer: Cash Price |
$4,471.48
|
| Rate for Payer: Cigna Commercial |
$7,422.65
|
| Rate for Payer: First Health Commercial |
$8,495.80
|
| Rate for Payer: Humana Commercial |
$7,601.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,333.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,599.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,869.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,707.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,788.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,162.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,772.31
|
| Rate for Payer: PHCS Commercial |
$8,585.23
|
| Rate for Payer: United Healthcare All Payer |
$7,869.80
|
|
|
OX TIB COMP SZ D LM
|
Facility
|
OP
|
$10,027.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$9,625.92 |
| Rate for Payer: Aetna Commercial |
$7,720.79
|
| Rate for Payer: Anthem Medicaid |
$3,448.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,821.06
|
| Rate for Payer: Cash Price |
$5,013.50
|
| Rate for Payer: Cigna Commercial |
$8,322.41
|
| Rate for Payer: First Health Commercial |
$9,525.65
|
| Rate for Payer: Humana Commercial |
$8,522.95
|
| Rate for Payer: Humana KY Medicaid |
$3,448.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,222.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,005.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,108.37
|
| Rate for Payer: PHCS Commercial |
$9,625.92
|
| Rate for Payer: United Healthcare All Payer |
$8,823.76
|
|
|
OX TIB COMP SZ D LM
|
Facility
|
IP
|
$10,027.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$9,625.92 |
| Rate for Payer: Aetna Commercial |
$7,720.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,821.06
|
| Rate for Payer: Cash Price |
$5,013.50
|
| Rate for Payer: Cigna Commercial |
$8,322.41
|
| Rate for Payer: First Health Commercial |
$9,525.65
|
| Rate for Payer: Humana Commercial |
$8,522.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,222.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,005.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,108.37
|
| Rate for Payer: PHCS Commercial |
$9,625.92
|
| Rate for Payer: United Healthcare All Payer |
$8,823.76
|
|
|
OX UNI MEN BEAR ANA LG SZ 3R
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 3R
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 4R
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 4R
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 6R
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 6R
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 7R
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 7R
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 8R
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 8R
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
