|
FEMUR AXLE LGN HK SZ 3
|
Facility
|
OP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem Medicaid |
$1,356.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Humana KY Medicaid |
$1,356.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,370.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR AXLE LGN HK SZ 4
|
Facility
|
OP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem Medicaid |
$1,356.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Humana KY Medicaid |
$1,356.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,370.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR AXLE LGN HK SZ 4
|
Facility
|
IP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR AXLE LGN HK SZ 5
|
Facility
|
OP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem Medicaid |
$1,356.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Humana KY Medicaid |
$1,356.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,370.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR AXLE LGN HK SZ 5
|
Facility
|
IP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR AXLE LGN HK SZ 7
|
Facility
|
OP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem Medicaid |
$1,356.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Humana KY Medicaid |
$1,356.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,370.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR AXLE LGN HK SZ 7
|
Facility
|
IP
|
$3,944.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$512.77 |
| Max. Negotiated Rate |
$3,786.62 |
| Rate for Payer: Aetna Commercial |
$3,037.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,076.63
|
| Rate for Payer: Cash Price |
$1,972.20
|
| Rate for Payer: Cigna Commercial |
$3,273.85
|
| Rate for Payer: First Health Commercial |
$3,747.18
|
| Rate for Payer: Humana Commercial |
$3,352.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,234.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,910.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,471.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,958.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$512.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.76
|
| Rate for Payer: PHCS Commercial |
$3,786.62
|
| Rate for Payer: United Healthcare All Payer |
$3,471.07
|
|
|
FEMUR ELEOS RESURFACING SZ 2 L
|
Facility
|
OP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem Medicaid |
$11,750.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Humana KY Medicaid |
$11,750.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURFACING SZ 2 L
|
Facility
|
IP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURFACING SZ 3 L
|
Facility
|
OP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem Medicaid |
$11,750.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Humana KY Medicaid |
$11,750.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURFACING SZ 3 L
|
Facility
|
IP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURFACING SZ 4
|
Facility
|
OP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem Medicaid |
$11,750.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Humana KY Medicaid |
$11,750.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURFACING SZ 4
|
Facility
|
IP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURF SZ 2 R
|
Facility
|
IP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURF SZ 2 R
|
Facility
|
OP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem Medicaid |
$11,750.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Humana KY Medicaid |
$11,750.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURF SZ 3 R
|
Facility
|
IP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURF SZ 3 R
|
Facility
|
OP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem Medicaid |
$11,750.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Humana KY Medicaid |
$11,750.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURF SZ 4 R
|
Facility
|
IP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR ELEOS RESURF SZ 4 R
|
Facility
|
OP
|
$34,167.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.83 |
| Max. Negotiated Rate |
$32,801.18 |
| Rate for Payer: Aetna Commercial |
$26,309.28
|
| Rate for Payer: Anthem Medicaid |
$11,750.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,650.96
|
| Rate for Payer: Cash Price |
$17,083.95
|
| Rate for Payer: Cigna Commercial |
$28,359.36
|
| Rate for Payer: First Health Commercial |
$32,459.50
|
| Rate for Payer: Humana Commercial |
$29,042.72
|
| Rate for Payer: Humana KY Medicaid |
$11,750.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,869.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,017.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,215.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,250.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,986.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,067.75
|
| Rate for Payer: Ohio Health Group HMO |
$25,625.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,833.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,592.05
|
| Rate for Payer: PHCS Commercial |
$32,801.18
|
| Rate for Payer: United Healthcare All Payer |
$30,067.75
|
|
|
FEMUR FIXED BEARING LT 11MM
|
Facility
|
IP
|
$8,868.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,152.86 |
| Max. Negotiated Rate |
$8,513.40 |
| Rate for Payer: Aetna Commercial |
$6,828.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,917.13
|
| Rate for Payer: Cash Price |
$4,434.06
|
| Rate for Payer: Cigna Commercial |
$7,360.54
|
| Rate for Payer: First Health Commercial |
$8,424.71
|
| Rate for Payer: Humana Commercial |
$7,537.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,271.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,544.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,660.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,803.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,651.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.12
|
| Rate for Payer: PHCS Commercial |
$8,513.40
|
| Rate for Payer: United Healthcare All Payer |
$7,803.95
|
|
|
FEMUR FIXED BEARING LT 11MM
|
Facility
|
OP
|
$8,868.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,152.86 |
| Max. Negotiated Rate |
$8,513.40 |
| Rate for Payer: Aetna Commercial |
$6,828.45
|
| Rate for Payer: Anthem Medicaid |
$3,049.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,917.13
|
| Rate for Payer: Cash Price |
$4,434.06
|
| Rate for Payer: Cigna Commercial |
$7,360.54
|
| Rate for Payer: First Health Commercial |
$8,424.71
|
| Rate for Payer: Humana Commercial |
$7,537.90
|
| Rate for Payer: Humana KY Medicaid |
$3,049.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,080.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,271.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,544.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,660.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,110.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,803.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,651.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.12
|
| Rate for Payer: PHCS Commercial |
$8,513.40
|
| Rate for Payer: United Healthcare All Payer |
$7,803.95
|
|
|
FEMUR LT (2V)
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
32000098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.76
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.02
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
FEMUR LT (2V)
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
32000098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$542.00 |
| Rate for Payer: Anthem Medicaid |
$24.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$542.00
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$50.77
|
| Rate for Payer: Humana Medicaid |
$24.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.66
|
| Rate for Payer: Molina Healthcare Passport |
$24.18
|
| Rate for Payer: Multiplan PHCS |
$325.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$379.40
|
| Rate for Payer: UHCCP Medicaid |
$189.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.42
|
|
|
FEMUR LT (2V)
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
32000098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.46 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: Aetna Commercial |
$417.34
|
| Rate for Payer: Anthem Medicaid |
$186.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$422.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cash Price |
$271.00
|
| Rate for Payer: Cigna Commercial |
$449.86
|
| Rate for Payer: First Health Commercial |
$514.90
|
| Rate for Payer: Humana Commercial |
$460.70
|
| Rate for Payer: Humana KY Medicaid |
$186.39
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$188.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.96
|
| Rate for Payer: Ohio Health Group HMO |
$406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.02
|
| Rate for Payer: PHCS Commercial |
$520.32
|
| Rate for Payer: United Healthcare All Payer |
$476.96
|
|
|
FEMUR LT (2V)(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
320P0098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Anthem Medicaid |
$24.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$50.77
|
| Rate for Payer: Humana Medicaid |
$24.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.66
|
| Rate for Payer: Molina Healthcare Passport |
$24.18
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.42
|
|
