|
FEMUR LT (2V)(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
320T0098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
FEMUR LT (2V)(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73552
|
| Hospital Charge Code |
320T0098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
FEMUR PSN CR CMT NAR SZ 10 L
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 10 L
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 10 R
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 10 R
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 11 L
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 11 L
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 11 R
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 11 R
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 24 L
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 24 L
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 4 R
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 4 R
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 5 L
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 5 L
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 6 L
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 6 L
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 6 R
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 6 R
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 7 L
|
Facility
|
IP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$15,782.40 |
| Rate for Payer: Aetna Commercial |
$12,658.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,823.20
|
| Rate for Payer: Cash Price |
$8,220.00
|
| Rate for Payer: Cigna Commercial |
$13,645.20
|
| Rate for Payer: First Health Commercial |
$15,618.00
|
| Rate for Payer: Humana Commercial |
$13,974.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,932.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,137.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,096.40
|
| Rate for Payer: PHCS Commercial |
$15,782.40
|
| Rate for Payer: United Healthcare All Payer |
$14,467.20
|
|
|
FEMUR PSN CR CMT NAR SZ 7 L
|
Facility
|
OP
|
$16,440.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,137.20 |
| Max. Negotiated Rate |
$15,782.40 |
| Rate for Payer: Aetna Commercial |
$12,658.80
|
| Rate for Payer: Anthem Medicaid |
$5,653.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,823.20
|
| Rate for Payer: Cash Price |
$8,220.00
|
| Rate for Payer: Cigna Commercial |
$13,645.20
|
| Rate for Payer: First Health Commercial |
$15,618.00
|
| Rate for Payer: Humana Commercial |
$13,974.00
|
| Rate for Payer: Humana KY Medicaid |
$5,653.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,711.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,480.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,132.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,932.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,137.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,096.40
|
| Rate for Payer: PHCS Commercial |
$15,782.40
|
| Rate for Payer: United Healthcare All Payer |
$14,467.20
|
|
|
FEMUR PSN CR CMT NAR SZ 7 R
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 7 R
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
FEMUR PSN CR CMT NAR SZ 8 L
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
