|
FEMUR PSN CR CMT NAR SZ 8 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 8 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 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 9 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 9 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 9 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 9 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 STD 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 STD 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 STD 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 STD 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 STD 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 STD 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 STD 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 STD 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 STD SZ 12 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 STD SZ 12 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 STD SZ 12 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 STD SZ 12 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 STD SZ 4 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 STD SZ 4 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 STD 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 STD 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 STD 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 STD 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
|
|
