|
SROM EXT TIB STEM 15*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 15*150MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 15*150MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 17*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 17*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 19*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 19*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 21*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 21*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM FEMORAL SLEEVE 18F LRG
|
Facility
|
OP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem Medicaid |
$4,257.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Humana KY Medicaid |
$4,257.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,301.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,343.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
|
SROM FEMORAL SLEEVE 18F LRG
|
Facility
|
IP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
|
SROM FEMORAL SLEEVE 20MM
|
Facility
|
OP
|
$5,560.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.12 |
| Max. Negotiated Rate |
$5,337.98 |
| Rate for Payer: Aetna Commercial |
$4,281.51
|
| Rate for Payer: Anthem Medicaid |
$1,912.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,337.11
|
| Rate for Payer: Cash Price |
$2,780.20
|
| Rate for Payer: Cigna Commercial |
$4,615.13
|
| Rate for Payer: First Health Commercial |
$5,282.38
|
| Rate for Payer: Humana Commercial |
$4,726.34
|
| Rate for Payer: Humana KY Medicaid |
$1,912.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,931.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,950.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,893.15
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,448.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,837.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,836.68
|
| Rate for Payer: PHCS Commercial |
$5,337.98
|
| Rate for Payer: United Healthcare All Payer |
$4,893.15
|
|
|
SROM FEMORAL SLEEVE 20MM
|
Facility
|
IP
|
$5,560.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.12 |
| Max. Negotiated Rate |
$5,337.98 |
| Rate for Payer: Aetna Commercial |
$4,281.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,337.11
|
| Rate for Payer: Cash Price |
$2,780.20
|
| Rate for Payer: Cigna Commercial |
$4,615.13
|
| Rate for Payer: First Health Commercial |
$5,282.38
|
| Rate for Payer: Humana Commercial |
$4,726.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,893.15
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,448.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,837.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,836.68
|
| Rate for Payer: PHCS Commercial |
$5,337.98
|
| Rate for Payer: United Healthcare All Payer |
$4,893.15
|
|
|
S-ROM FEMORAL STEM RT LONG
|
Facility
|
OP
|
$33,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,016.25 |
| Max. Negotiated Rate |
$32,052.00 |
| Rate for Payer: Aetna Commercial |
$25,708.38
|
| Rate for Payer: Anthem Medicaid |
$11,481.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,042.25
|
| Rate for Payer: Cash Price |
$16,693.75
|
| Rate for Payer: Cigna Commercial |
$27,711.62
|
| Rate for Payer: First Health Commercial |
$31,718.12
|
| Rate for Payer: Humana Commercial |
$28,379.38
|
| Rate for Payer: Humana KY Medicaid |
$11,481.96
|
| Rate for Payer: Kentucky WC Medicaid |
$11,598.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,377.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,639.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,016.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,712.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,381.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,047.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,037.38
|
| Rate for Payer: PHCS Commercial |
$32,052.00
|
| Rate for Payer: United Healthcare All Payer |
$29,381.00
|
|
|
S-ROM FEMORAL STEM RT LONG
|
Facility
|
IP
|
$33,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,016.25 |
| Max. Negotiated Rate |
$32,052.00 |
| Rate for Payer: Aetna Commercial |
$25,708.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,042.25
|
| Rate for Payer: Cash Price |
$16,693.75
|
| Rate for Payer: Cigna Commercial |
$27,711.62
|
| Rate for Payer: First Health Commercial |
$31,718.12
|
| Rate for Payer: Humana Commercial |
$28,379.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,377.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,639.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,016.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,381.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,040.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,047.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,037.38
|
| Rate for Payer: PHCS Commercial |
$32,052.00
|
| Rate for Payer: United Healthcare All Payer |
$29,381.00
|
|
|
SROM FEM STM 18*13*215 LT LNG
|
Facility
|
IP
|
$27,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,205.00 |
| Max. Negotiated Rate |
$26,256.00 |
| Rate for Payer: Aetna Commercial |
$21,059.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,333.00
|
| Rate for Payer: Cash Price |
$13,675.00
|
| Rate for Payer: Cigna Commercial |
$22,700.50
|
| Rate for Payer: First Health Commercial |
$25,982.50
|
| Rate for Payer: Humana Commercial |
$23,247.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,427.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,184.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,794.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,871.50
|
| Rate for Payer: PHCS Commercial |
$26,256.00
|
| Rate for Payer: United Healthcare All Payer |
$24,068.00
|
|
|
SROM FEM STM 18*13*215 LT LNG
|
Facility
|
OP
|
$27,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,205.00 |
| Max. Negotiated Rate |
$26,256.00 |
| Rate for Payer: Aetna Commercial |
$21,059.50
|
| Rate for Payer: Anthem Medicaid |
$9,405.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,333.00
|
| Rate for Payer: Cash Price |
$13,675.00
|
| Rate for Payer: Cigna Commercial |
$22,700.50
|
| Rate for Payer: First Health Commercial |
$25,982.50
|
| Rate for Payer: Humana Commercial |
$23,247.50
|
| Rate for Payer: Humana KY Medicaid |
$9,405.67
|
| Rate for Payer: Kentucky WC Medicaid |
$9,501.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,427.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,184.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,594.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,794.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,871.50
|
| Rate for Payer: PHCS Commercial |
$26,256.00
|
| Rate for Payer: United Healthcare All Payer |
$24,068.00
|
|
|
SROM FEM STM 18*13*255 R XLG
|
Facility
|
IP
|
$31,175.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,352.50 |
| Max. Negotiated Rate |
$29,928.00 |
| Rate for Payer: Aetna Commercial |
$24,004.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,316.50
|
| Rate for Payer: Cash Price |
$15,587.50
|
| Rate for Payer: Cigna Commercial |
$25,875.25
|
| Rate for Payer: First Health Commercial |
$29,616.25
|
| Rate for Payer: Humana Commercial |
$26,498.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,563.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,007.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,434.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,381.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,122.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,510.75
|
| Rate for Payer: PHCS Commercial |
$29,928.00
|
| Rate for Payer: United Healthcare All Payer |
$27,434.00
|
|
|
SROM FEM STM 18*13*255 R XLG
|
Facility
|
OP
|
$31,175.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,352.50 |
| Max. Negotiated Rate |
$29,928.00 |
| Rate for Payer: Aetna Commercial |
$24,004.75
|
| Rate for Payer: Anthem Medicaid |
$10,721.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,316.50
|
| Rate for Payer: Cash Price |
$15,587.50
|
| Rate for Payer: Cigna Commercial |
$25,875.25
|
| Rate for Payer: First Health Commercial |
$29,616.25
|
| Rate for Payer: Humana Commercial |
$26,498.75
|
| Rate for Payer: Humana KY Medicaid |
$10,721.08
|
| Rate for Payer: Kentucky WC Medicaid |
$10,830.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,563.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,007.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,936.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,434.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,381.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,122.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,510.75
|
| Rate for Payer: PHCS Commercial |
$29,928.00
|
| Rate for Payer: United Healthcare All Payer |
$27,434.00
|
|
|
S-ROM HEAD FEM COCR 22 +0
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
S-ROM HEAD FEM COCR 22 +0
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
S-ROM HEAD FEM COCR 26 +0
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
S-ROM HEAD FEM COCR 26 +0
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
S-ROM HEAD FEM COCR 26 +6
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
S-ROM HEAD FEM COCR 26 +6
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
