|
PFC DIST. AUG. 4*4MM RT
|
Facility
|
OP
|
$8,567.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.78 |
| Max. Negotiated Rate |
$8,224.85 |
| Rate for Payer: Aetna Commercial |
$6,597.01
|
| Rate for Payer: Anthem Medicaid |
$2,946.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
| Rate for Payer: Cash Price |
$4,283.77
|
| Rate for Payer: Cigna Commercial |
$7,111.07
|
| Rate for Payer: First Health Commercial |
$8,139.17
|
| Rate for Payer: Humana Commercial |
$7,282.42
|
| Rate for Payer: Humana KY Medicaid |
$2,946.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
| Rate for Payer: PHCS Commercial |
$8,224.85
|
| Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
|
PFC FEM HEAD 22.225MM +10MM
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
PFC FEM HEAD 22.225MM +10MM
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
PFC FEMORAL HEAD 22.225MM +0MM
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
PFC FEMORAL HEAD 22.225MM +0MM
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
PFC FEMORAL HEAD 22.225MM +5MM
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
PFC FEMORAL HEAD 22.225MM +5MM
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
PF CHEST
|
Professional
|
Both
|
$1,500.00
|
|
| Hospital Charge Code |
22200311
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
|
|
PF Chest - PP Visit 1 50%
|
Professional
|
Both
|
$1,913.00
|
|
| Hospital Charge Code |
22200312
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$669.55 |
| Max. Negotiated Rate |
$1,913.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,913.00
|
| Rate for Payer: Cash Price |
$956.50
|
| Rate for Payer: Multiplan PHCS |
$1,147.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,339.10
|
| Rate for Payer: UHCCP Medicaid |
$669.55
|
|
|
PF Chest - PP Visit 2/3 25%
|
Professional
|
Both
|
$956.00
|
|
| Hospital Charge Code |
22200521
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$334.60 |
| Max. Negotiated Rate |
$956.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$956.00
|
| Rate for Payer: Cash Price |
$478.00
|
| Rate for Payer: Multiplan PHCS |
$573.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$669.20
|
| Rate for Payer: UHCCP Medicaid |
$334.60
|
|
|
PFC MOD KNEE SYS CEM STEM 13*3
|
Facility
|
IP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 13*3
|
Facility
|
OP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem Medicaid |
$2,931.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Humana KY Medicaid |
$2,931.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 13*6
|
Facility
|
OP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem Medicaid |
$2,931.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Humana KY Medicaid |
$2,931.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 13*6
|
Facility
|
IP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*3
|
Facility
|
IP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*3
|
Facility
|
OP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem Medicaid |
$2,931.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Humana KY Medicaid |
$2,931.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*6
|
Facility
|
IP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC MOD KNEE SYS CEM STEM 15*6
|
Facility
|
OP
|
$8,524.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.13 |
| Max. Negotiated Rate |
$8,183.15 |
| Rate for Payer: Aetna Commercial |
$6,563.56
|
| Rate for Payer: Anthem Medicaid |
$2,931.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,648.81
|
| Rate for Payer: Cash Price |
$4,262.06
|
| Rate for Payer: Cigna Commercial |
$7,075.01
|
| Rate for Payer: First Health Commercial |
$8,097.90
|
| Rate for Payer: Humana Commercial |
$7,245.49
|
| Rate for Payer: Humana KY Medicaid |
$2,931.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,989.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,290.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,501.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,393.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,704.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.47
|
| Rate for Payer: PHCS Commercial |
$8,183.15
|
| Rate for Payer: United Healthcare All Payer |
$7,501.22
|
|
|
PFC POST AUG. COMBO 4*4MM
|
Facility
|
OP
|
$8,716.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.16 |
| Max. Negotiated Rate |
$8,367.98 |
| Rate for Payer: Aetna Commercial |
$6,711.82
|
| Rate for Payer: Anthem Medicaid |
$2,997.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,798.99
|
| Rate for Payer: Cash Price |
$4,358.32
|
| Rate for Payer: Cigna Commercial |
$7,234.82
|
| Rate for Payer: First Health Commercial |
$8,280.82
|
| Rate for Payer: Humana Commercial |
$7,409.15
|
| Rate for Payer: Humana KY Medicaid |
$2,997.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,028.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,147.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,432.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,057.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,670.65
|
| Rate for Payer: Ohio Health Group HMO |
$6,537.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,133.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.16
|
| Rate for Payer: PHCS Commercial |
$8,367.98
|
| Rate for Payer: United Healthcare All Payer |
$7,670.65
|
|
|
PFC POST AUG. COMBO 4*4MM
|
Facility
|
IP
|
$8,716.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.16 |
| Max. Negotiated Rate |
$8,367.98 |
| Rate for Payer: Aetna Commercial |
$6,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,798.99
|
| Rate for Payer: Cash Price |
$4,358.32
|
| Rate for Payer: Cigna Commercial |
$7,234.82
|
| Rate for Payer: First Health Commercial |
$8,280.82
|
| Rate for Payer: Humana Commercial |
$7,409.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,147.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,432.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,670.65
|
| Rate for Payer: Ohio Health Group HMO |
$6,537.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,133.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.16
|
| Rate for Payer: PHCS Commercial |
$8,367.98
|
| Rate for Payer: United Healthcare All Payer |
$7,670.65
|
|
|
PFC POST AUG. COMBO 4*8MM
|
Facility
|
IP
|
$7,107.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.91 |
| Max. Negotiated Rate |
$6,822.72 |
| Rate for Payer: Aetna Commercial |
$5,472.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,543.46
|
| Rate for Payer: Cash Price |
$3,553.50
|
| Rate for Payer: Cigna Commercial |
$5,898.81
|
| Rate for Payer: First Health Commercial |
$6,751.65
|
| Rate for Payer: Humana Commercial |
$6,040.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,132.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,254.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$6,822.72
|
| Rate for Payer: United Healthcare All Payer |
$6,254.16
|
|
|
PFC POST AUG. COMBO 4*8MM
|
Facility
|
OP
|
$7,107.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.91 |
| Max. Negotiated Rate |
$6,822.72 |
| Rate for Payer: Aetna Commercial |
$5,472.39
|
| Rate for Payer: Anthem Medicaid |
$2,444.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,543.46
|
| Rate for Payer: Cash Price |
$3,553.50
|
| Rate for Payer: Cigna Commercial |
$5,898.81
|
| Rate for Payer: First Health Commercial |
$6,751.65
|
| Rate for Payer: Humana Commercial |
$6,040.95
|
| Rate for Payer: Humana KY Medicaid |
$2,444.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,132.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,493.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,254.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,330.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$6,822.72
|
| Rate for Payer: United Healthcare All Payer |
$6,254.16
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 4M
|
Facility
|
IP
|
$8,567.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.78 |
| Max. Negotiated Rate |
$8,224.85 |
| Rate for Payer: Aetna Commercial |
$6,597.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
| Rate for Payer: Cash Price |
$4,283.77
|
| Rate for Payer: Cigna Commercial |
$7,111.07
|
| Rate for Payer: First Health Commercial |
$8,139.17
|
| Rate for Payer: Humana Commercial |
$7,282.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
| Rate for Payer: PHCS Commercial |
$8,224.85
|
| Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 4M
|
Facility
|
OP
|
$8,567.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.78 |
| Max. Negotiated Rate |
$8,224.85 |
| Rate for Payer: Aetna Commercial |
$6,597.01
|
| Rate for Payer: Anthem Medicaid |
$2,946.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
| Rate for Payer: Cash Price |
$4,283.77
|
| Rate for Payer: Cigna Commercial |
$7,111.07
|
| Rate for Payer: First Health Commercial |
$8,139.17
|
| Rate for Payer: Humana Commercial |
$7,282.42
|
| Rate for Payer: Humana KY Medicaid |
$2,946.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
| Rate for Payer: PHCS Commercial |
$8,224.85
|
| Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
|
PFC*SIG FEM POST AUG SZ 2.5 8M
|
Facility
|
IP
|
$8,567.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.78 |
| Max. Negotiated Rate |
$8,224.85 |
| Rate for Payer: Aetna Commercial |
$6,597.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.69
|
| Rate for Payer: Cash Price |
$4,283.77
|
| Rate for Payer: Cigna Commercial |
$7,111.07
|
| Rate for Payer: First Health Commercial |
$8,139.17
|
| Rate for Payer: Humana Commercial |
$7,282.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.94
|
| Rate for Payer: PHCS Commercial |
$8,224.85
|
| Rate for Payer: United Healthcare All Payer |
$7,539.44
|
|
