|
OX PART KNEE TWIN PEG FEM SM
|
Facility
|
OP
|
$12,296.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,689.10 |
| Max. Negotiated Rate |
$11,805.11 |
| Rate for Payer: Aetna Commercial |
$9,468.68
|
| Rate for Payer: Anthem Medicaid |
$4,228.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,591.65
|
| Rate for Payer: Cash Price |
$6,148.50
|
| Rate for Payer: Cigna Commercial |
$10,206.50
|
| Rate for Payer: First Health Commercial |
$11,682.14
|
| Rate for Payer: Humana Commercial |
$10,452.44
|
| Rate for Payer: Humana KY Medicaid |
$4,228.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,271.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,083.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,075.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,689.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,313.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,821.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,222.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,698.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,484.92
|
| Rate for Payer: PHCS Commercial |
$11,805.11
|
| Rate for Payer: United Healthcare All Payer |
$10,821.35
|
|
|
OX PART KNEE TWIN PEG FEM SM
|
Facility
|
IP
|
$12,296.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,689.10 |
| Max. Negotiated Rate |
$11,805.11 |
| Rate for Payer: Aetna Commercial |
$9,468.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,591.65
|
| Rate for Payer: Cash Price |
$6,148.50
|
| Rate for Payer: Cigna Commercial |
$10,206.50
|
| Rate for Payer: First Health Commercial |
$11,682.14
|
| Rate for Payer: Humana Commercial |
$10,452.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,083.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,075.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,689.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,821.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,222.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,698.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,484.92
|
| Rate for Payer: PHCS Commercial |
$11,805.11
|
| Rate for Payer: United Healthcare All Payer |
$10,821.35
|
|
|
OX PART KNEE TWIN PEG FEM X LG
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX PART KNEE TWIN PEG FEM X LG
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX PART KNEE TWIN PEG FEM XS
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX PART KNEE TWIN PEG FEM XS
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX TIB COMP SZ AA LM
|
Facility
|
OP
|
$10,227.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.10 |
| Max. Negotiated Rate |
$9,817.92 |
| Rate for Payer: Aetna Commercial |
$7,874.79
|
| Rate for Payer: Anthem Medicaid |
$3,517.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,977.06
|
| Rate for Payer: Cash Price |
$5,113.50
|
| Rate for Payer: Cigna Commercial |
$8,488.41
|
| Rate for Payer: First Health Commercial |
$9,715.65
|
| Rate for Payer: Humana Commercial |
$8,692.95
|
| Rate for Payer: Humana KY Medicaid |
$3,517.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,552.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,547.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,587.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,999.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,670.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,897.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,056.63
|
| Rate for Payer: PHCS Commercial |
$9,817.92
|
| Rate for Payer: United Healthcare All Payer |
$8,999.76
|
|
|
OX TIB COMP SZ AA LM
|
Facility
|
IP
|
$10,227.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.10 |
| Max. Negotiated Rate |
$9,817.92 |
| Rate for Payer: Aetna Commercial |
$7,874.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,977.06
|
| Rate for Payer: Cash Price |
$5,113.50
|
| Rate for Payer: Cigna Commercial |
$8,488.41
|
| Rate for Payer: First Health Commercial |
$9,715.65
|
| Rate for Payer: Humana Commercial |
$8,692.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,547.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,999.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,670.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,897.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,056.63
|
| Rate for Payer: PHCS Commercial |
$9,817.92
|
| Rate for Payer: United Healthcare All Payer |
$8,999.76
|
|
|
OX TIB COMP SZ B RM
|
Facility
|
IP
|
$9,142.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,742.89 |
| Max. Negotiated Rate |
$8,777.23 |
| Rate for Payer: Aetna Commercial |
$7,040.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,131.50
|
| Rate for Payer: Cash Price |
$4,571.48
|
| Rate for Payer: Cigna Commercial |
$7,588.65
|
| Rate for Payer: First Health Commercial |
$8,685.80
|
| Rate for Payer: Humana Commercial |
$7,771.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,497.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,747.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,045.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,857.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,314.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,954.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,308.64
|
| Rate for Payer: PHCS Commercial |
$8,777.23
|
| Rate for Payer: United Healthcare All Payer |
$8,045.80
|
|
|
OX TIB COMP SZ B RM
|
Facility
|
OP
|
$9,142.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,742.89 |
| Max. Negotiated Rate |
$8,777.23 |
| Rate for Payer: Aetna Commercial |
$7,040.07
|
| Rate for Payer: Anthem Medicaid |
$3,144.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,131.50
|
| Rate for Payer: Cash Price |
$4,571.48
|
| Rate for Payer: Cigna Commercial |
$7,588.65
|
| Rate for Payer: First Health Commercial |
$8,685.80
|
| Rate for Payer: Humana Commercial |
$7,771.51
|
| Rate for Payer: Humana KY Medicaid |
$3,144.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,176.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,497.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,747.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,207.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,045.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,857.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,314.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,954.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,308.64
|
| Rate for Payer: PHCS Commercial |
$8,777.23
|
| Rate for Payer: United Healthcare All Payer |
$8,045.80
|
|
|
OX TIB COMP SZ D LM
|
Facility
|
IP
|
$10,227.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.10 |
| Max. Negotiated Rate |
$9,817.92 |
| Rate for Payer: Aetna Commercial |
$7,874.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,977.06
|
| Rate for Payer: Cash Price |
$5,113.50
|
| Rate for Payer: Cigna Commercial |
$8,488.41
|
| Rate for Payer: First Health Commercial |
$9,715.65
|
| Rate for Payer: Humana Commercial |
$8,692.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,547.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,999.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,670.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,897.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,056.63
|
| Rate for Payer: PHCS Commercial |
$9,817.92
|
| Rate for Payer: United Healthcare All Payer |
$8,999.76
|
|
|
OX TIB COMP SZ D LM
|
Facility
|
OP
|
$10,227.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.10 |
| Max. Negotiated Rate |
$9,817.92 |
| Rate for Payer: Aetna Commercial |
$7,874.79
|
| Rate for Payer: Anthem Medicaid |
$3,517.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,977.06
|
| Rate for Payer: Cash Price |
$5,113.50
|
| Rate for Payer: Cigna Commercial |
$8,488.41
|
| Rate for Payer: First Health Commercial |
$9,715.65
|
| Rate for Payer: Humana Commercial |
$8,692.95
|
| Rate for Payer: Humana KY Medicaid |
$3,517.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,552.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,547.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,587.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,999.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,670.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,897.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,056.63
|
| Rate for Payer: PHCS Commercial |
$9,817.92
|
| Rate for Payer: United Healthcare All Payer |
$8,999.76
|
|
|
OX UNI MEN BEAR ANA LG SZ 3R
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 3R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 4R
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 4R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 6R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 6R
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 7R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 7R
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 8R
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 8R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 9R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA LG SZ 9R
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX UNI MEN BEAR ANA MED SZ 3R
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
