|
BI-METRIC FEMORAL COMP 10*130
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 10*130
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 11*135
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 11*135
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 12*140
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 12*140
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 13*145
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 13*145
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 14*150
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 14*150
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 15*155
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 15*155
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 16*160
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 16*160
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 17*165
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 17*165
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 18*170
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 18*170
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 19*175
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 19*175
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 20*180
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 20*180
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 21*185
|
Facility
|
OP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem Medicaid |
$7,567.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Humana KY Medicaid |
$7,567.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,644.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,719.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 21*185
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
|
BI-METRIC FEMORAL COMP 8*120
|
Facility
|
IP
|
$22,006.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,860.79 |
| Max. Negotiated Rate |
$21,125.86 |
| Rate for Payer: Aetna Commercial |
$16,944.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,164.76
|
| Rate for Payer: Cash Price |
$11,003.05
|
| Rate for Payer: Cigna Commercial |
$18,265.06
|
| Rate for Payer: First Health Commercial |
$20,905.80
|
| Rate for Payer: Humana Commercial |
$18,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,240.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,601.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,365.37
|
| Rate for Payer: Ohio Health Group HMO |
$16,504.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,401.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.89
|
| Rate for Payer: PHCS Commercial |
$21,125.86
|
| Rate for Payer: United Healthcare All Payer |
$19,365.37
|
|
