|
FEMUR PSN CR CMT STD SZ 5 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 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 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 STD 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 STD SZ 7 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 7 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 7 R
|
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 STD SZ 7 R
|
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 STD 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 STD 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
|
|
|
FEMUR PSN CR CMT STD 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 STD 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 STD 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 STD 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 STD 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 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 MCVE ASF R 10M 12/GH
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MCVE ASF R 10M 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MC VE ASF R 10M 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MC VE ASF R 10M 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MCVE ASF R 11M 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MCVE ASF R 11M 12/GH
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MC VE ASF R 11M 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MC VE ASF R 11M 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
FEMUR PSN MCVE ASF R 12M 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
