|
TRI TS FEMUR SZ 2 RIGHT
|
Facility
|
IP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 3 LEFT
|
Facility
|
IP
|
$32,874.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,273.66 |
| Max. Negotiated Rate |
$31,559.37 |
| Rate for Payer: Aetna Commercial |
$25,313.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,641.99
|
| Rate for Payer: Cash Price |
$16,437.17
|
| Rate for Payer: Cigna Commercial |
$27,285.70
|
| Rate for Payer: First Health Commercial |
$31,230.62
|
| Rate for Payer: Humana Commercial |
$27,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,956.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,261.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,862.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,929.42
|
| Rate for Payer: Ohio Health Group HMO |
$24,655.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,574.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,273.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.05
|
| Rate for Payer: PHCS Commercial |
$31,559.37
|
| Rate for Payer: United Healthcare All Payer |
$28,929.42
|
|
|
TRI TS FEMUR SZ 3 LEFT
|
Facility
|
OP
|
$32,874.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,273.66 |
| Max. Negotiated Rate |
$31,559.37 |
| Rate for Payer: Aetna Commercial |
$25,313.24
|
| Rate for Payer: Anthem Medicaid |
$11,305.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,641.99
|
| Rate for Payer: Cash Price |
$16,437.17
|
| Rate for Payer: Cigna Commercial |
$27,285.70
|
| Rate for Payer: First Health Commercial |
$31,230.62
|
| Rate for Payer: Humana Commercial |
$27,943.19
|
| Rate for Payer: Humana KY Medicaid |
$11,305.49
|
| Rate for Payer: Kentucky WC Medicaid |
$11,420.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,956.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,261.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,862.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,532.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,929.42
|
| Rate for Payer: Ohio Health Group HMO |
$24,655.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,574.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,273.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.05
|
| Rate for Payer: PHCS Commercial |
$31,559.37
|
| Rate for Payer: United Healthcare All Payer |
$28,929.42
|
|
|
TRI TS FEMUR SZ 3 RIGHT
|
Facility
|
OP
|
$27,217.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.23 |
| Max. Negotiated Rate |
$26,128.48 |
| Rate for Payer: Aetna Commercial |
$20,957.22
|
| Rate for Payer: Anthem Medicaid |
$9,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,229.39
|
| Rate for Payer: Cash Price |
$13,608.58
|
| Rate for Payer: Cigna Commercial |
$22,590.25
|
| Rate for Payer: First Health Commercial |
$25,856.31
|
| Rate for Payer: Humana Commercial |
$23,134.59
|
| Rate for Payer: Humana KY Medicaid |
$9,359.98
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,318.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,086.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,547.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,951.11
|
| Rate for Payer: Ohio Health Group HMO |
$20,412.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,443.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,437.32
|
| Rate for Payer: PHCS Commercial |
$26,128.48
|
| Rate for Payer: United Healthcare All Payer |
$23,951.11
|
|
|
TRI TS FEMUR SZ 3 RIGHT
|
Facility
|
IP
|
$27,217.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.23 |
| Max. Negotiated Rate |
$26,128.48 |
| Rate for Payer: Aetna Commercial |
$20,957.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,229.39
|
| Rate for Payer: Cash Price |
$13,608.58
|
| Rate for Payer: Cigna Commercial |
$22,590.25
|
| Rate for Payer: First Health Commercial |
$25,856.31
|
| Rate for Payer: Humana Commercial |
$23,134.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,318.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,086.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,951.11
|
| Rate for Payer: Ohio Health Group HMO |
$20,412.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,443.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,437.32
|
| Rate for Payer: PHCS Commercial |
$26,128.48
|
| Rate for Payer: United Healthcare All Payer |
$23,951.11
|
|
|
TRI TS FEMUR SZ 4 LEFT
|
Facility
|
OP
|
$27,217.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.23 |
| Max. Negotiated Rate |
$26,128.48 |
| Rate for Payer: Aetna Commercial |
$20,957.22
|
| Rate for Payer: Anthem Medicaid |
$9,359.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,229.39
|
| Rate for Payer: Cash Price |
$13,608.58
|
| Rate for Payer: Cigna Commercial |
$22,590.25
|
| Rate for Payer: First Health Commercial |
$25,856.31
|
| Rate for Payer: Humana Commercial |
$23,134.59
|
| Rate for Payer: Humana KY Medicaid |
$9,359.98
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,318.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,086.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,547.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,951.11
|
| Rate for Payer: Ohio Health Group HMO |
$20,412.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,443.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,437.32
|
| Rate for Payer: PHCS Commercial |
$26,128.48
|
| Rate for Payer: United Healthcare All Payer |
$23,951.11
|
|
|
TRI TS FEMUR SZ 4 LEFT
|
Facility
|
IP
|
$27,217.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.23 |
| Max. Negotiated Rate |
$26,128.48 |
| Rate for Payer: Aetna Commercial |
$20,957.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,229.39
|
| Rate for Payer: Cash Price |
$13,608.58
|
| Rate for Payer: Cigna Commercial |
$22,590.25
|
| Rate for Payer: First Health Commercial |
$25,856.31
|
| Rate for Payer: Humana Commercial |
$23,134.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,318.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,086.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,951.11
|
| Rate for Payer: Ohio Health Group HMO |
$20,412.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,443.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,437.32
|
| Rate for Payer: PHCS Commercial |
$26,128.48
|
| Rate for Payer: United Healthcare All Payer |
$23,951.11
|
|
|
TRI TS FEMUR SZ 4 RIGHT
|
Facility
|
IP
|
$35,166.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,571.60 |
| Max. Negotiated Rate |
$33,759.53 |
| Rate for Payer: Aetna Commercial |
$27,077.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,429.62
|
| Rate for Payer: Cash Price |
$17,583.09
|
| Rate for Payer: Cigna Commercial |
$29,187.93
|
| Rate for Payer: First Health Commercial |
$33,407.87
|
| Rate for Payer: Humana Commercial |
$29,891.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,836.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,952.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,549.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$26,374.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,033.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.52
|
| Rate for Payer: PHCS Commercial |
$33,759.53
|
| Rate for Payer: United Healthcare All Payer |
$30,946.24
|
|
|
TRI TS FEMUR SZ 4 RIGHT
|
Facility
|
OP
|
$35,166.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,571.60 |
| Max. Negotiated Rate |
$33,759.53 |
| Rate for Payer: Aetna Commercial |
$27,077.96
|
| Rate for Payer: Anthem Medicaid |
$12,093.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,429.62
|
| Rate for Payer: Cash Price |
$17,583.09
|
| Rate for Payer: Cigna Commercial |
$29,187.93
|
| Rate for Payer: First Health Commercial |
$33,407.87
|
| Rate for Payer: Humana Commercial |
$29,891.25
|
| Rate for Payer: Humana KY Medicaid |
$12,093.65
|
| Rate for Payer: Kentucky WC Medicaid |
$12,216.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,836.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,952.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,549.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,336.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$26,374.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,033.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.52
|
| Rate for Payer: PHCS Commercial |
$33,759.53
|
| Rate for Payer: United Healthcare All Payer |
$30,946.24
|
|
|
TRI TS FEMUR SZ 5 LEFT
|
Facility
|
IP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 5 LEFT
|
Facility
|
OP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem Medicaid |
$10,758.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Humana KY Medicaid |
$10,758.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10,868.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,974.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 5 RIGHT
|
Facility
|
OP
|
$35,166.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,571.60 |
| Max. Negotiated Rate |
$33,759.53 |
| Rate for Payer: Aetna Commercial |
$27,077.96
|
| Rate for Payer: Anthem Medicaid |
$12,093.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,429.62
|
| Rate for Payer: Cash Price |
$17,583.09
|
| Rate for Payer: Cigna Commercial |
$29,187.93
|
| Rate for Payer: First Health Commercial |
$33,407.87
|
| Rate for Payer: Humana Commercial |
$29,891.25
|
| Rate for Payer: Humana KY Medicaid |
$12,093.65
|
| Rate for Payer: Kentucky WC Medicaid |
$12,216.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,836.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,952.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,549.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,336.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$26,374.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,033.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.52
|
| Rate for Payer: PHCS Commercial |
$33,759.53
|
| Rate for Payer: United Healthcare All Payer |
$30,946.24
|
|
|
TRI TS FEMUR SZ 5 RIGHT
|
Facility
|
IP
|
$35,166.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,571.60 |
| Max. Negotiated Rate |
$33,759.53 |
| Rate for Payer: Aetna Commercial |
$27,077.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,429.62
|
| Rate for Payer: Cash Price |
$17,583.09
|
| Rate for Payer: Cigna Commercial |
$29,187.93
|
| Rate for Payer: First Health Commercial |
$33,407.87
|
| Rate for Payer: Humana Commercial |
$29,891.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,836.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,952.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,549.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$26,374.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,033.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.52
|
| Rate for Payer: PHCS Commercial |
$33,759.53
|
| Rate for Payer: United Healthcare All Payer |
$30,946.24
|
|
|
TRI TS FEMUR SZ 6 LEFT
|
Facility
|
OP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem Medicaid |
$10,758.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Humana KY Medicaid |
$10,758.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10,868.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,974.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 6 LEFT
|
Facility
|
IP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 6 RIGHT
|
Facility
|
OP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem Medicaid |
$10,758.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Humana KY Medicaid |
$10,758.96
|
| Rate for Payer: Kentucky WC Medicaid |
$10,868.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,974.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 6 RIGHT
|
Facility
|
IP
|
$31,285.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,067.07 |
| Max. Negotiated Rate |
$30,033.72 |
| Rate for Payer: Aetna Commercial |
$24,089.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,402.40
|
| Rate for Payer: Cash Price |
$15,642.57
|
| Rate for Payer: Cigna Commercial |
$25,966.66
|
| Rate for Payer: First Health Commercial |
$29,720.87
|
| Rate for Payer: Humana Commercial |
$26,592.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,653.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,088.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,385.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,530.91
|
| Rate for Payer: Ohio Health Group HMO |
$23,463.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,257.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,067.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,698.39
|
| Rate for Payer: PHCS Commercial |
$30,033.72
|
| Rate for Payer: United Healthcare All Payer |
$27,530.91
|
|
|
TRI TS FEMUR SZ 7 LEFT
|
Facility
|
OP
|
$28,063.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.23 |
| Max. Negotiated Rate |
$26,940.75 |
| Rate for Payer: Aetna Commercial |
$21,608.73
|
| Rate for Payer: Anthem Medicaid |
$9,650.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,889.36
|
| Rate for Payer: Cash Price |
$14,031.64
|
| Rate for Payer: Cigna Commercial |
$23,292.52
|
| Rate for Payer: First Health Commercial |
$26,660.12
|
| Rate for Payer: Humana Commercial |
$23,853.79
|
| Rate for Payer: Humana KY Medicaid |
$9,650.96
|
| Rate for Payer: Kentucky WC Medicaid |
$9,749.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,011.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,710.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,418.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,844.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$21,047.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,699.62
|
| Rate for Payer: PHCS Commercial |
$26,940.75
|
| Rate for Payer: United Healthcare All Payer |
$24,695.69
|
|
|
TRI TS FEMUR SZ 7 LEFT
|
Facility
|
IP
|
$28,063.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.23 |
| Max. Negotiated Rate |
$26,940.75 |
| Rate for Payer: Aetna Commercial |
$21,608.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,889.36
|
| Rate for Payer: Cash Price |
$14,031.64
|
| Rate for Payer: Cigna Commercial |
$23,292.52
|
| Rate for Payer: First Health Commercial |
$26,660.12
|
| Rate for Payer: Humana Commercial |
$23,853.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,011.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,710.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,418.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$21,047.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,699.62
|
| Rate for Payer: PHCS Commercial |
$26,940.75
|
| Rate for Payer: United Healthcare All Payer |
$24,695.69
|
|
|
TRI TS FEMUR SZ 7 RIGHT
|
Facility
|
IP
|
$35,166.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,571.60 |
| Max. Negotiated Rate |
$33,759.53 |
| Rate for Payer: Aetna Commercial |
$27,077.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,429.62
|
| Rate for Payer: Cash Price |
$17,583.09
|
| Rate for Payer: Cigna Commercial |
$29,187.93
|
| Rate for Payer: First Health Commercial |
$33,407.87
|
| Rate for Payer: Humana Commercial |
$29,891.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,836.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,952.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,549.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$26,374.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,033.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.52
|
| Rate for Payer: PHCS Commercial |
$33,759.53
|
| Rate for Payer: United Healthcare All Payer |
$30,946.24
|
|
|
TRI TS FEMUR SZ 7 RIGHT
|
Facility
|
OP
|
$35,166.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,571.60 |
| Max. Negotiated Rate |
$33,759.53 |
| Rate for Payer: Aetna Commercial |
$27,077.96
|
| Rate for Payer: Anthem Medicaid |
$12,093.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,429.62
|
| Rate for Payer: Cash Price |
$17,583.09
|
| Rate for Payer: Cigna Commercial |
$29,187.93
|
| Rate for Payer: First Health Commercial |
$33,407.87
|
| Rate for Payer: Humana Commercial |
$29,891.25
|
| Rate for Payer: Humana KY Medicaid |
$12,093.65
|
| Rate for Payer: Kentucky WC Medicaid |
$12,216.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,836.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,952.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,549.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,336.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$26,374.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,033.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,901.52
|
| Rate for Payer: PHCS Commercial |
$33,759.53
|
| Rate for Payer: United Healthcare All Payer |
$30,946.24
|
|
|
TRI TS FEMUR SZ 8 LEFT
|
Facility
|
IP
|
$32,874.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,273.66 |
| Max. Negotiated Rate |
$31,559.37 |
| Rate for Payer: Aetna Commercial |
$25,313.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,641.99
|
| Rate for Payer: Cash Price |
$16,437.17
|
| Rate for Payer: Cigna Commercial |
$27,285.70
|
| Rate for Payer: First Health Commercial |
$31,230.62
|
| Rate for Payer: Humana Commercial |
$27,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,956.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,261.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,862.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,929.42
|
| Rate for Payer: Ohio Health Group HMO |
$24,655.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,574.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,273.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.05
|
| Rate for Payer: PHCS Commercial |
$31,559.37
|
| Rate for Payer: United Healthcare All Payer |
$28,929.42
|
|
|
TRI TS FEMUR SZ 8 LEFT
|
Facility
|
OP
|
$32,874.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,273.66 |
| Max. Negotiated Rate |
$31,559.37 |
| Rate for Payer: Aetna Commercial |
$25,313.24
|
| Rate for Payer: Anthem Medicaid |
$11,305.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,641.99
|
| Rate for Payer: Cash Price |
$16,437.17
|
| Rate for Payer: Cigna Commercial |
$27,285.70
|
| Rate for Payer: First Health Commercial |
$31,230.62
|
| Rate for Payer: Humana Commercial |
$27,943.19
|
| Rate for Payer: Humana KY Medicaid |
$11,305.49
|
| Rate for Payer: Kentucky WC Medicaid |
$11,420.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,956.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,261.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,862.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,532.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,929.42
|
| Rate for Payer: Ohio Health Group HMO |
$24,655.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,574.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,273.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,191.05
|
| Rate for Payer: PHCS Commercial |
$31,559.37
|
| Rate for Payer: United Healthcare All Payer |
$28,929.42
|
|
|
TRI TS FEMUR SZ 8 RIGHT
|
Facility
|
OP
|
$28,063.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.23 |
| Max. Negotiated Rate |
$26,940.75 |
| Rate for Payer: Aetna Commercial |
$21,608.73
|
| Rate for Payer: Anthem Medicaid |
$9,650.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,889.36
|
| Rate for Payer: Cash Price |
$14,031.64
|
| Rate for Payer: Cigna Commercial |
$23,292.52
|
| Rate for Payer: First Health Commercial |
$26,660.12
|
| Rate for Payer: Humana Commercial |
$23,853.79
|
| Rate for Payer: Humana KY Medicaid |
$9,650.96
|
| Rate for Payer: Kentucky WC Medicaid |
$9,749.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,011.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,710.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,418.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,844.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$21,047.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,699.62
|
| Rate for Payer: PHCS Commercial |
$26,940.75
|
| Rate for Payer: United Healthcare All Payer |
$24,695.69
|
|
|
TRI TS FEMUR SZ 8 RIGHT
|
Facility
|
IP
|
$28,063.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.23 |
| Max. Negotiated Rate |
$26,940.75 |
| Rate for Payer: Aetna Commercial |
$21,608.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,889.36
|
| Rate for Payer: Cash Price |
$14,031.64
|
| Rate for Payer: Cigna Commercial |
$23,292.52
|
| Rate for Payer: First Health Commercial |
$26,660.12
|
| Rate for Payer: Humana Commercial |
$23,853.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,011.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,710.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,418.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$21,047.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,648.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,699.62
|
| Rate for Payer: PHCS Commercial |
$26,940.75
|
| Rate for Payer: United Healthcare All Payer |
$24,695.69
|
|
