|
S-ROM HEAD FEM COCR 28 +0
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 28 +12
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 28 +12
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 28 +6
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 28 +6
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 32 +0
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 32 +0
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 32 +12
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 32 +12
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 32 +6
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
S-ROM HEAD FEM COCR 32 +6
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
SROM KNEE FEM EXT STR
|
Facility
|
IP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM KNEE FEM EXT STR
|
Facility
|
OP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem Medicaid |
$2,316.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Humana KY Medicaid |
$2,316.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM KNEE FEM EXT STR 17*100MM
|
Facility
|
OP
|
$68,303.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.41 |
| Max. Negotiated Rate |
$65,571.01 |
| Rate for Payer: Aetna Commercial |
$52,593.42
|
| Rate for Payer: Anthem Medicaid |
$23,489.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,276.45
|
| Rate for Payer: Cash Price |
$34,151.57
|
| Rate for Payer: Cigna Commercial |
$56,691.61
|
| Rate for Payer: First Health Commercial |
$64,887.98
|
| Rate for Payer: Humana Commercial |
$58,057.67
|
| Rate for Payer: Humana KY Medicaid |
$23,489.45
|
| Rate for Payer: Kentucky WC Medicaid |
$23,728.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,008.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,407.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,490.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,960.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,106.76
|
| Rate for Payer: Ohio Health Group HMO |
$51,227.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,660.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,879.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,173.97
|
| Rate for Payer: PHCS Commercial |
$65,571.01
|
| Rate for Payer: United Healthcare All Payer |
$60,106.76
|
|
|
SROM KNEE FEM EXT STR 17*100MM
|
Facility
|
IP
|
$68,303.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,879.41 |
| Max. Negotiated Rate |
$65,571.01 |
| Rate for Payer: Aetna Commercial |
$52,593.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,276.45
|
| Rate for Payer: Cash Price |
$34,151.57
|
| Rate for Payer: Cigna Commercial |
$56,691.61
|
| Rate for Payer: First Health Commercial |
$64,887.98
|
| Rate for Payer: Humana Commercial |
$58,057.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,008.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,407.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,490.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,106.76
|
| Rate for Payer: Ohio Health Group HMO |
$51,227.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,660.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,879.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,173.97
|
| Rate for Payer: PHCS Commercial |
$65,571.01
|
| Rate for Payer: United Healthcare All Payer |
$60,106.76
|
|
|
SROM KNEE FEM EXT STR 17*150MM
|
Facility
|
OP
|
$7,290.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.80 |
| Max. Negotiated Rate |
$6,999.11 |
| Rate for Payer: Aetna Commercial |
$5,613.87
|
| Rate for Payer: Anthem Medicaid |
$2,507.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.78
|
| Rate for Payer: Cash Price |
$3,645.37
|
| Rate for Payer: Cigna Commercial |
$6,051.31
|
| Rate for Payer: First Health Commercial |
$6,926.20
|
| Rate for Payer: Humana Commercial |
$6,197.13
|
| Rate for Payer: Humana KY Medicaid |
$2,507.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,468.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.13
|
| Rate for Payer: PHCS Commercial |
$6,999.11
|
| Rate for Payer: United Healthcare All Payer |
$6,415.85
|
|
|
SROM KNEE FEM EXT STR 17*150MM
|
Facility
|
IP
|
$7,290.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.80 |
| Max. Negotiated Rate |
$6,999.11 |
| Rate for Payer: Aetna Commercial |
$5,613.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.78
|
| Rate for Payer: Cash Price |
$3,645.37
|
| Rate for Payer: Cigna Commercial |
$6,051.31
|
| Rate for Payer: First Health Commercial |
$6,926.20
|
| Rate for Payer: Humana Commercial |
$6,197.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,468.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.13
|
| Rate for Payer: PHCS Commercial |
$6,999.11
|
| Rate for Payer: United Healthcare All Payer |
$6,415.85
|
|
|
SROM KNEE FEM EXT STR 19*100MM
|
Facility
|
IP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM KNEE FEM EXT STR 19*100MM
|
Facility
|
OP
|
$6,737.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.82 |
| Max. Negotiated Rate |
$6,467.59 |
| Rate for Payer: Aetna Commercial |
$5,187.54
|
| Rate for Payer: Anthem Medicaid |
$2,316.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,254.91
|
| Rate for Payer: Cash Price |
$3,368.54
|
| Rate for Payer: Cigna Commercial |
$5,591.77
|
| Rate for Payer: First Health Commercial |
$6,400.22
|
| Rate for Payer: Humana Commercial |
$5,726.51
|
| Rate for Payer: Humana KY Medicaid |
$2,316.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,524.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,971.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,928.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,052.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.49
|
| Rate for Payer: PHCS Commercial |
$6,467.59
|
| Rate for Payer: United Healthcare All Payer |
$5,928.62
|
|
|
SROM KNEE FEM SLEEVE POR 31MM
|
Facility
|
IP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM KNEE FEM SLEEVE POR 31MM
|
Facility
|
OP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem Medicaid |
$3,085.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Humana KY Medicaid |
$3,085.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,116.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,147.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM KNEE FEM SLEEVE POR 34MM
|
Facility
|
OP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem Medicaid |
$3,085.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Humana KY Medicaid |
$3,085.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,116.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,147.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM KNEE FEM SLEEVE POR 34MM
|
Facility
|
IP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM KNEE FEM SLEEVE POR 40MM
|
Facility
|
IP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
|
SROM KNEE FEM SLEEVE POR 40MM
|
Facility
|
OP
|
$8,972.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.38 |
| Max. Negotiated Rate |
$8,613.30 |
| Rate for Payer: Aetna Commercial |
$6,908.59
|
| Rate for Payer: Anthem Medicaid |
$3,085.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,998.31
|
| Rate for Payer: Cash Price |
$4,486.09
|
| Rate for Payer: Cigna Commercial |
$7,446.92
|
| Rate for Payer: First Health Commercial |
$8,523.58
|
| Rate for Payer: Humana Commercial |
$7,626.36
|
| Rate for Payer: Humana KY Medicaid |
$3,085.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,116.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,357.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,621.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,147.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,729.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,781.38
|
| Rate for Payer: PHCS Commercial |
$8,613.30
|
| Rate for Payer: United Healthcare All Payer |
$7,895.53
|
|
