|
PKR BASEPLATE #5 LM/RL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #5RM / LL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #5RM / LL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #6 LM/RL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #6 LM/RL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #6RM / LL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #6RM / LL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR FEMUR #1 LM/RL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #1 LM/RL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #1 RM/LL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #1 RM/LL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #2 LM/RL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #2 LM/RL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #2 RM/LL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #2 RM/LL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #3 LM/RL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #3 LM/RL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #3 RM/LL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #3 RM/LL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #4 LM/RL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #4 LM/RL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #4 RM/LL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR #4 RM/LL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR # 5 LM/RL
|
Facility
|
IP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
|
PKR FEMUR # 5 LM/RL
|
Facility
|
OP
|
$13,301.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.13 |
| Max. Negotiated Rate |
$12,768.96 |
| Rate for Payer: Aetna Commercial |
$10,241.77
|
| Rate for Payer: Anthem Medicaid |
$4,574.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,374.78
|
| Rate for Payer: Cash Price |
$6,650.50
|
| Rate for Payer: Cigna Commercial |
$11,039.83
|
| Rate for Payer: First Health Commercial |
$12,635.95
|
| Rate for Payer: Humana Commercial |
$11,305.85
|
| Rate for Payer: Humana KY Medicaid |
$4,574.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,620.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,906.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,816.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,704.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,660.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,123.31
|
| Rate for Payer: PHCS Commercial |
$12,768.96
|
| Rate for Payer: United Healthcare All Payer |
$11,704.88
|
|
