|
PKR BASEPLATE #3 LM/RL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #3 LM/RL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #3 RM / LL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #3 RM / LL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #4 LM/RL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #4 LM/RL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #4 RM / LL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #4 RM / LL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #5 LM/RL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #5 LM/RL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #5RM / LL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #5RM / LL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #6 LM/RL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #6 LM/RL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #6RM / LL
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR BASEPLATE #6RM / LL
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PKR FEMUR #1 LM/RL
|
Facility
|
IP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #1 LM/RL
|
Facility
|
OP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem Medicaid |
$4,661.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Humana KY Medicaid |
$4,661.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,709.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #1 RM/LL
|
Facility
|
OP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem Medicaid |
$4,661.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Humana KY Medicaid |
$4,661.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,709.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #1 RM/LL
|
Facility
|
IP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #2 LM/RL
|
Facility
|
OP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem Medicaid |
$4,661.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Humana KY Medicaid |
$4,661.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,709.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #2 LM/RL
|
Facility
|
IP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #2 RM/LL
|
Facility
|
OP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem Medicaid |
$4,661.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Humana KY Medicaid |
$4,661.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,709.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #2 RM/LL
|
Facility
|
IP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
|
PKR FEMUR #3 LM/RL
|
Facility
|
OP
|
$13,555.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,066.74 |
| Max. Negotiated Rate |
$13,013.57 |
| Rate for Payer: Aetna Commercial |
$10,437.97
|
| Rate for Payer: Anthem Medicaid |
$4,661.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,573.52
|
| Rate for Payer: Cash Price |
$6,777.90
|
| Rate for Payer: Cigna Commercial |
$11,251.31
|
| Rate for Payer: First Health Commercial |
$12,878.01
|
| Rate for Payer: Humana Commercial |
$11,522.43
|
| Rate for Payer: Humana KY Medicaid |
$4,661.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,709.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,115.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,004.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,066.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,929.10
|
| Rate for Payer: Ohio Health Group HMO |
$10,166.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,844.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,793.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,353.50
|
| Rate for Payer: PHCS Commercial |
$13,013.57
|
| Rate for Payer: United Healthcare All Payer |
$11,929.10
|
|
