|
FEMORAL JIG RT LD LOW PROFILE
|
Facility
|
IP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.45 |
| Max. Negotiated Rate |
$5,438.40 |
| Rate for Payer: Aetna Commercial |
$4,362.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.70
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cigna Commercial |
$4,701.95
|
| Rate for Payer: First Health Commercial |
$5,381.75
|
| Rate for Payer: Humana Commercial |
$4,815.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.15
|
| Rate for Payer: PHCS Commercial |
$5,438.40
|
| Rate for Payer: United Healthcare All Payer |
$4,985.20
|
|
|
FEMORAL JIG RT LD LOW PROFILE
|
Facility
|
OP
|
$5,665.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$736.45 |
| Max. Negotiated Rate |
$5,438.40 |
| Rate for Payer: Aetna Commercial |
$4,362.05
|
| Rate for Payer: Anthem Medicaid |
$1,948.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.70
|
| Rate for Payer: Cash Price |
$2,832.50
|
| Rate for Payer: Cigna Commercial |
$4,701.95
|
| Rate for Payer: First Health Commercial |
$5,381.75
|
| Rate for Payer: Humana Commercial |
$4,815.25
|
| Rate for Payer: Humana KY Medicaid |
$1,948.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$736.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,756.15
|
| Rate for Payer: PHCS Commercial |
$5,438.40
|
| Rate for Payer: United Healthcare All Payer |
$4,985.20
|
|
|
FEMORAL JIG TAIL LEFT LD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG TAIL LEFT LD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG TAIL RIGHT LD
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
FEMORAL JIG TAIL RIGHT LD
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
FEMORAL LEFT-WITH SCREW 70MM
|
Facility
|
OP
|
$38,090.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.70 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$29,329.31
|
| Rate for Payer: Anthem Medicaid |
$13,099.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,710.21
|
| Rate for Payer: Cash Price |
$19,045.00
|
| Rate for Payer: Cigna Commercial |
$31,614.71
|
| Rate for Payer: First Health Commercial |
$36,185.51
|
| Rate for Payer: Humana Commercial |
$32,376.51
|
| Rate for Payer: Humana KY Medicaid |
$13,099.15
|
| Rate for Payer: Kentucky WC Medicaid |
$13,232.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,233.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,110.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,427.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,361.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,519.21
|
| Rate for Payer: Ohio Health Group HMO |
$28,567.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,618.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,951.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,807.90
|
| Rate for Payer: PHCS Commercial |
$36,566.41
|
| Rate for Payer: United Healthcare All Payer |
$33,519.21
|
|
|
FEMORAL LEFT-WITH SCREW 70MM
|
Facility
|
IP
|
$38,090.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.70 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$29,329.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,710.21
|
| Rate for Payer: Cash Price |
$19,045.00
|
| Rate for Payer: Cigna Commercial |
$31,614.71
|
| Rate for Payer: First Health Commercial |
$36,185.51
|
| Rate for Payer: Humana Commercial |
$32,376.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,233.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,110.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,427.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,519.21
|
| Rate for Payer: Ohio Health Group HMO |
$28,567.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,618.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,951.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,807.90
|
| Rate for Payer: PHCS Commercial |
$36,566.41
|
| Rate for Payer: United Healthcare All Payer |
$33,519.21
|
|
|
FEMORAL MOD TAPER 12.5*146
|
Facility
|
OP
|
$21,341.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,774.43 |
| Max. Negotiated Rate |
$20,488.13 |
| Rate for Payer: Aetna Commercial |
$16,433.19
|
| Rate for Payer: Anthem Medicaid |
$7,339.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,646.60
|
| Rate for Payer: Cash Price |
$10,670.90
|
| Rate for Payer: Cigna Commercial |
$17,713.69
|
| Rate for Payer: First Health Commercial |
$20,274.71
|
| Rate for Payer: Humana Commercial |
$18,140.53
|
| Rate for Payer: Humana KY Medicaid |
$7,339.45
|
| Rate for Payer: Kentucky WC Medicaid |
$7,414.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,500.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,750.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,402.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,486.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,780.78
|
| Rate for Payer: Ohio Health Group HMO |
$16,006.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,268.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,774.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.96
|
| Rate for Payer: PHCS Commercial |
$20,488.13
|
| Rate for Payer: United Healthcare All Payer |
$18,780.78
|
|
|
FEMORAL MOD TAPER 12.5*146
|
Facility
|
IP
|
$21,341.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,774.43 |
| Max. Negotiated Rate |
$20,488.13 |
| Rate for Payer: Aetna Commercial |
$16,433.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,646.60
|
| Rate for Payer: Cash Price |
$10,670.90
|
| Rate for Payer: Cigna Commercial |
$17,713.69
|
| Rate for Payer: First Health Commercial |
$20,274.71
|
| Rate for Payer: Humana Commercial |
$18,140.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,500.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,750.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,402.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,780.78
|
| Rate for Payer: Ohio Health Group HMO |
$16,006.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,268.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,774.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.96
|
| Rate for Payer: PHCS Commercial |
$20,488.13
|
| Rate for Payer: United Healthcare All Payer |
$18,780.78
|
|
|
FEMORAL NEXGEN ROT HINGE B-LT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE B-LT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE B-RT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE B-RT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE C-LT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE C-LT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE C-RT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE C-RT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE D-LT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE D-LT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE D-RT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE D-RT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE E-LT
|
Facility
|
IP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE E-LT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
|
FEMORAL NEXGEN ROT HINGE E-RT
|
Facility
|
OP
|
$37,065.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.56 |
| Max. Negotiated Rate |
$35,583.19 |
| Rate for Payer: Aetna Commercial |
$28,540.68
|
| Rate for Payer: Anthem Medicaid |
$12,746.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,911.34
|
| Rate for Payer: Cash Price |
$18,532.91
|
| Rate for Payer: Cigna Commercial |
$30,764.63
|
| Rate for Payer: First Health Commercial |
$35,212.53
|
| Rate for Payer: Humana Commercial |
$31,505.95
|
| Rate for Payer: Humana KY Medicaid |
$12,746.94
|
| Rate for Payer: Kentucky WC Medicaid |
$12,876.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,354.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,002.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,617.92
|
| Rate for Payer: Ohio Health Group HMO |
$27,799.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,413.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,818.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,490.40
|
| Rate for Payer: PHCS Commercial |
$35,583.19
|
| Rate for Payer: United Healthcare All Payer |
$32,617.92
|
|
