|
FEMORAL JIG TAIL LEFT LD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG TAIL RIGHT LD
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
FEMORAL JIG TAIL RIGHT LD
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
FEMORAL LEFT-WITH SCREW 70MM
|
Facility
|
IP
|
$39,202.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,760.62 |
| Max. Negotiated Rate |
$37,633.98 |
| Rate for Payer: Aetna Commercial |
$30,185.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,577.61
|
| Rate for Payer: Cash Price |
$19,601.03
|
| Rate for Payer: Cigna Commercial |
$32,537.71
|
| Rate for Payer: First Health Commercial |
$37,241.96
|
| Rate for Payer: Humana Commercial |
$33,321.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,145.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,931.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,760.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,497.81
|
| Rate for Payer: Ohio Health Group HMO |
$29,401.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,361.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,105.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,049.42
|
| Rate for Payer: PHCS Commercial |
$37,633.98
|
| Rate for Payer: United Healthcare All Payer |
$34,497.81
|
|
|
FEMORAL LEFT-WITH SCREW 70MM
|
Facility
|
OP
|
$39,202.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,760.62 |
| Max. Negotiated Rate |
$37,633.98 |
| Rate for Payer: Aetna Commercial |
$30,185.59
|
| Rate for Payer: Anthem Medicaid |
$13,481.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,577.61
|
| Rate for Payer: Cash Price |
$19,601.03
|
| Rate for Payer: Cigna Commercial |
$32,537.71
|
| Rate for Payer: First Health Commercial |
$37,241.96
|
| Rate for Payer: Humana Commercial |
$33,321.75
|
| Rate for Payer: Humana KY Medicaid |
$13,481.59
|
| Rate for Payer: Kentucky WC Medicaid |
$13,618.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,145.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,931.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,760.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,752.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,497.81
|
| Rate for Payer: Ohio Health Group HMO |
$29,401.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,361.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,105.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,049.42
|
| Rate for Payer: PHCS Commercial |
$37,633.98
|
| Rate for Payer: United Healthcare All Payer |
$34,497.81
|
|
|
FEMORAL MOD TAPER 12.5*146
|
Facility
|
IP
|
$21,995.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,598.50 |
| Max. Negotiated Rate |
$21,115.20 |
| Rate for Payer: Aetna Commercial |
$16,936.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,156.10
|
| Rate for Payer: Cash Price |
$10,997.50
|
| Rate for Payer: Cigna Commercial |
$18,255.85
|
| Rate for Payer: First Health Commercial |
$20,895.25
|
| Rate for Payer: Humana Commercial |
$18,695.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,035.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,232.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,598.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,355.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,496.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,135.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,176.55
|
| Rate for Payer: PHCS Commercial |
$21,115.20
|
| Rate for Payer: United Healthcare All Payer |
$19,355.60
|
|
|
FEMORAL MOD TAPER 12.5*146
|
Facility
|
OP
|
$21,995.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,598.50 |
| Max. Negotiated Rate |
$21,115.20 |
| Rate for Payer: Aetna Commercial |
$16,936.15
|
| Rate for Payer: Anthem Medicaid |
$7,564.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,156.10
|
| Rate for Payer: Cash Price |
$10,997.50
|
| Rate for Payer: Cigna Commercial |
$18,255.85
|
| Rate for Payer: First Health Commercial |
$20,895.25
|
| Rate for Payer: Humana Commercial |
$18,695.75
|
| Rate for Payer: Humana KY Medicaid |
$7,564.08
|
| Rate for Payer: Kentucky WC Medicaid |
$7,641.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,035.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,232.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,598.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,715.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,355.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,496.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,135.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,176.55
|
| Rate for Payer: PHCS Commercial |
$21,115.20
|
| Rate for Payer: United Healthcare All Payer |
$19,355.60
|
|
|
FEMORAL NEXGEN ROT HINGE B-LT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE B-LT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE B-RT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE B-RT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE C-LT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE C-LT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE C-RT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE C-RT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE D-LT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE D-LT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE D-RT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE D-RT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE E-LT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE E-LT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE E-RT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE E-RT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE F-LT
|
Facility
|
IP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
|
FEMORAL NEXGEN ROT HINGE F-LT
|
Facility
|
OP
|
$38,149.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,444.94 |
| Max. Negotiated Rate |
$36,623.82 |
| Rate for Payer: Aetna Commercial |
$29,375.35
|
| Rate for Payer: Anthem Medicaid |
$13,119.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,756.85
|
| Rate for Payer: Cash Price |
$19,074.91
|
| Rate for Payer: Cigna Commercial |
$31,664.34
|
| Rate for Payer: First Health Commercial |
$36,242.32
|
| Rate for Payer: Humana Commercial |
$32,427.34
|
| Rate for Payer: Humana KY Medicaid |
$13,119.72
|
| Rate for Payer: Kentucky WC Medicaid |
$13,253.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,282.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,154.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,444.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,382.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,571.83
|
| Rate for Payer: Ohio Health Group HMO |
$28,612.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,519.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,190.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,323.37
|
| Rate for Payer: PHCS Commercial |
$36,623.82
|
| Rate for Payer: United Healthcare All Payer |
$33,571.83
|
|
