|
S-ROM HEAD FEM COCR 28 +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 28 +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 28 +12
|
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 28 +12
|
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 28 +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 28 +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
|
|
|
S-ROM HEAD FEM COCR 32 +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 32 +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 32 +12
|
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 32 +12
|
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 32 +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
|
|
|
S-ROM HEAD FEM COCR 32 +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
|
|
|
SROM KNEE FEM EXT STR
|
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 KNEE FEM EXT STR
|
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 KNEE FEM EXT STR 17*100MM
|
Facility
|
IP
|
$70,458.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,137.66 |
| Max. Negotiated Rate |
$67,640.52 |
| Rate for Payer: Aetna Commercial |
$54,253.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,957.92
|
| Rate for Payer: Cash Price |
$35,229.43
|
| Rate for Payer: Cigna Commercial |
$58,480.86
|
| Rate for Payer: First Health Commercial |
$66,935.93
|
| Rate for Payer: Humana Commercial |
$59,890.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,776.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,998.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,137.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,003.81
|
| Rate for Payer: Ohio Health Group HMO |
$52,844.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,367.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,299.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,616.62
|
| Rate for Payer: PHCS Commercial |
$67,640.52
|
| Rate for Payer: United Healthcare All Payer |
$62,003.81
|
|
|
SROM KNEE FEM EXT STR 17*100MM
|
Facility
|
OP
|
$70,458.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,137.66 |
| Max. Negotiated Rate |
$67,640.52 |
| Rate for Payer: Aetna Commercial |
$54,253.33
|
| Rate for Payer: Anthem Medicaid |
$24,230.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,957.92
|
| Rate for Payer: Cash Price |
$35,229.43
|
| Rate for Payer: Cigna Commercial |
$58,480.86
|
| Rate for Payer: First Health Commercial |
$66,935.93
|
| Rate for Payer: Humana Commercial |
$59,890.04
|
| Rate for Payer: Humana KY Medicaid |
$24,230.81
|
| Rate for Payer: Kentucky WC Medicaid |
$24,477.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,776.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,998.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,137.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,716.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,003.81
|
| Rate for Payer: Ohio Health Group HMO |
$52,844.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,367.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,299.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,616.62
|
| Rate for Payer: PHCS Commercial |
$67,640.52
|
| Rate for Payer: United Healthcare All Payer |
$62,003.81
|
|
|
SROM KNEE FEM EXT STR 17*150MM
|
Facility
|
IP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM KNEE FEM EXT STR 17*150MM
|
Facility
|
OP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem Medicaid |
$2,576.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Humana KY Medicaid |
$2,576.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM KNEE FEM EXT STR 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 KNEE FEM EXT STR 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 KNEE FEM SLEEVE POR 31MM
|
Facility
|
OP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem Medicaid |
$3,154.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Humana KY Medicaid |
$3,154.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,186.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,217.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM KNEE FEM SLEEVE POR 31MM
|
Facility
|
IP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM KNEE FEM SLEEVE POR 34MM
|
Facility
|
OP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem Medicaid |
$3,154.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Humana KY Medicaid |
$3,154.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,186.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,217.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM KNEE FEM SLEEVE POR 34MM
|
Facility
|
IP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
|
SROM KNEE FEM SLEEVE POR 40MM
|
Facility
|
IP
|
$9,172.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.66 |
| Max. Negotiated Rate |
$8,805.30 |
| Rate for Payer: Aetna Commercial |
$7,062.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,154.31
|
| Rate for Payer: Cash Price |
$4,586.09
|
| Rate for Payer: Cigna Commercial |
$7,612.92
|
| Rate for Payer: First Health Commercial |
$8,713.58
|
| Rate for Payer: Humana Commercial |
$7,796.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,521.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,769.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,071.53
|
| Rate for Payer: Ohio Health Group HMO |
$6,879.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,337.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,979.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,328.81
|
| Rate for Payer: PHCS Commercial |
$8,805.30
|
| Rate for Payer: United Healthcare All Payer |
$8,071.53
|
|
