|
FEMORAL NEXGEN ROT HINGE F-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 F-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 PEGS FLEX GII LOK
|
Facility
|
OP
|
$3,776.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.09 |
| Max. Negotiated Rate |
$3,625.90 |
| Rate for Payer: Aetna Commercial |
$2,908.27
|
| Rate for Payer: Anthem Medicaid |
$1,298.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.04
|
| Rate for Payer: Cash Price |
$1,888.49
|
| Rate for Payer: Cigna Commercial |
$3,134.89
|
| Rate for Payer: First Health Commercial |
$3,588.13
|
| Rate for Payer: Humana Commercial |
$3,210.43
|
| Rate for Payer: Humana KY Medicaid |
$1,298.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,323.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,832.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,021.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.12
|
| Rate for Payer: PHCS Commercial |
$3,625.90
|
| Rate for Payer: United Healthcare All Payer |
$3,323.74
|
|
|
FEMORAL PEGS FLEX GII LOK
|
Facility
|
IP
|
$3,776.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.09 |
| Max. Negotiated Rate |
$3,625.90 |
| Rate for Payer: Aetna Commercial |
$2,908.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.04
|
| Rate for Payer: Cash Price |
$1,888.49
|
| Rate for Payer: Cigna Commercial |
$3,134.89
|
| Rate for Payer: First Health Commercial |
$3,588.13
|
| Rate for Payer: Humana Commercial |
$3,210.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,323.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,832.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,021.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.12
|
| Rate for Payer: PHCS Commercial |
$3,625.90
|
| Rate for Payer: United Healthcare All Payer |
$3,323.74
|
|
|
FEMORAL PROX ADAP MT 4CM*30D R
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX ADAP MT 4CM*30D R
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN CPS 10CM R
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN CPS 10CM R
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 7CM L
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 7CM L
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 7CM R
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 7CM R
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 8.5CM L
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 8.5CM L
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 8.5CM R
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL PROX FINN OSS 8.5CM R
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEMORAL RT W/SCREW 67.5MM
|
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 RT W/SCREW 67.5MM
|
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 RT W/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 RT W/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 SHAFT SPLIT FD
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
FEMORAL SHAFT SPLIT FD
|
Facility
|
IP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
FEMORAL SIZE A LM/RL
|
Facility
|
OP
|
$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 Medicaid |
$7.91
|
| 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: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| 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: Molina Healthcare Medicaid |
$8.07
|
| 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 SIZE A LM/RL
|
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 SIZE A RM/LL
|
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
|
|
