|
HEAD LEGACY COCR 12/14 38MM -4
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM +8
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM +8
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM -8
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM -8
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LGY PR CR 12/14 28M +10.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LGY PR CR 12/14 28M +10.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD/NECK HIP STEM #11*35MM
|
Facility
|
IP
|
$12,760.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.90 |
| Max. Negotiated Rate |
$12,250.37 |
| Rate for Payer: Aetna Commercial |
$9,825.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,953.42
|
| Rate for Payer: Cash Price |
$6,380.40
|
| Rate for Payer: Cigna Commercial |
$10,591.46
|
| Rate for Payer: First Health Commercial |
$12,122.76
|
| Rate for Payer: Humana Commercial |
$10,846.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,463.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,417.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,828.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,229.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,570.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,552.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,658.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,955.85
|
| Rate for Payer: PHCS Commercial |
$12,250.37
|
| Rate for Payer: United Healthcare All Payer |
$11,229.50
|
|
|
HEAD/NECK HIP STEM #11*35MM
|
Facility
|
OP
|
$12,760.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.90 |
| Max. Negotiated Rate |
$12,250.37 |
| Rate for Payer: Aetna Commercial |
$9,825.82
|
| Rate for Payer: Anthem Medicaid |
$4,388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,953.42
|
| Rate for Payer: Cash Price |
$6,380.40
|
| Rate for Payer: Cigna Commercial |
$10,591.46
|
| Rate for Payer: First Health Commercial |
$12,122.76
|
| Rate for Payer: Humana Commercial |
$10,846.68
|
| Rate for Payer: Humana KY Medicaid |
$4,388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$4,433.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,463.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,417.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,828.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,476.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,229.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,570.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,552.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,658.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,955.85
|
| Rate for Payer: PHCS Commercial |
$12,250.37
|
| Rate for Payer: United Healthcare All Payer |
$11,229.50
|
|
|
HEAD/NECK HIP STEM # 5
|
Facility
|
OP
|
$15,633.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,032.37 |
| Max. Negotiated Rate |
$15,008.26 |
| Rate for Payer: Aetna Commercial |
$12,037.87
|
| Rate for Payer: Anthem Medicaid |
$5,376.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,194.21
|
| Rate for Payer: Cash Price |
$7,816.80
|
| Rate for Payer: Cigna Commercial |
$12,975.89
|
| Rate for Payer: First Health Commercial |
$14,851.92
|
| Rate for Payer: Humana Commercial |
$13,288.56
|
| Rate for Payer: Humana KY Medicaid |
$5,376.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,431.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,819.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,690.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,484.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,757.57
|
| Rate for Payer: Ohio Health Group HMO |
$11,725.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,032.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,846.42
|
| Rate for Payer: PHCS Commercial |
$15,008.26
|
| Rate for Payer: United Healthcare All Payer |
$13,757.57
|
|
|
HEAD/NECK HIP STEM # 5
|
Facility
|
IP
|
$15,633.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,032.37 |
| Max. Negotiated Rate |
$15,008.26 |
| Rate for Payer: Aetna Commercial |
$12,037.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,194.21
|
| Rate for Payer: Cash Price |
$7,816.80
|
| Rate for Payer: Cigna Commercial |
$12,975.89
|
| Rate for Payer: First Health Commercial |
$14,851.92
|
| Rate for Payer: Humana Commercial |
$13,288.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,819.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,690.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,757.57
|
| Rate for Payer: Ohio Health Group HMO |
$11,725.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,032.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,846.42
|
| Rate for Payer: PHCS Commercial |
$15,008.26
|
| Rate for Payer: United Healthcare All Payer |
$13,757.57
|
|
|
HEAD/NECK HIP STEM #7*35MM
|
Facility
|
IP
|
$16,022.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.91 |
| Max. Negotiated Rate |
$15,381.50 |
| Rate for Payer: Aetna Commercial |
$12,337.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,497.47
|
| Rate for Payer: Cash Price |
$8,011.20
|
| Rate for Payer: Cigna Commercial |
$13,298.59
|
| Rate for Payer: First Health Commercial |
$15,221.28
|
| Rate for Payer: Humana Commercial |
$13,619.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,138.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,824.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,806.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,099.71
|
| Rate for Payer: Ohio Health Group HMO |
$12,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,204.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,082.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.94
|
| Rate for Payer: PHCS Commercial |
$15,381.50
|
| Rate for Payer: United Healthcare All Payer |
$14,099.71
|
|
|
HEAD/NECK HIP STEM #7*35MM
|
Facility
|
OP
|
$16,022.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.91 |
| Max. Negotiated Rate |
$15,381.50 |
| Rate for Payer: Aetna Commercial |
$12,337.25
|
| Rate for Payer: Anthem Medicaid |
$5,510.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,497.47
|
| Rate for Payer: Cash Price |
$8,011.20
|
| Rate for Payer: Cigna Commercial |
$13,298.59
|
| Rate for Payer: First Health Commercial |
$15,221.28
|
| Rate for Payer: Humana Commercial |
$13,619.04
|
| Rate for Payer: Humana KY Medicaid |
$5,510.10
|
| Rate for Payer: Kentucky WC Medicaid |
$5,566.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,138.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,824.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,806.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,620.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,099.71
|
| Rate for Payer: Ohio Health Group HMO |
$12,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,204.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,082.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.94
|
| Rate for Payer: PHCS Commercial |
$15,381.50
|
| Rate for Payer: United Healthcare All Payer |
$14,099.71
|
|
|
HEAD/NECK HIP STEM #9*35MM
|
Facility
|
OP
|
$12,760.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.90 |
| Max. Negotiated Rate |
$12,250.37 |
| Rate for Payer: Aetna Commercial |
$9,825.82
|
| Rate for Payer: Anthem Medicaid |
$4,388.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,953.42
|
| Rate for Payer: Cash Price |
$6,380.40
|
| Rate for Payer: Cigna Commercial |
$10,591.46
|
| Rate for Payer: First Health Commercial |
$12,122.76
|
| Rate for Payer: Humana Commercial |
$10,846.68
|
| Rate for Payer: Humana KY Medicaid |
$4,388.44
|
| Rate for Payer: Kentucky WC Medicaid |
$4,433.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,463.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,417.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,828.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,476.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,229.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,570.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,552.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,658.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,955.85
|
| Rate for Payer: PHCS Commercial |
$12,250.37
|
| Rate for Payer: United Healthcare All Payer |
$11,229.50
|
|
|
HEAD/NECK HIP STEM #9*35MM
|
Facility
|
IP
|
$12,760.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.90 |
| Max. Negotiated Rate |
$12,250.37 |
| Rate for Payer: Aetna Commercial |
$9,825.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,953.42
|
| Rate for Payer: Cash Price |
$6,380.40
|
| Rate for Payer: Cigna Commercial |
$10,591.46
|
| Rate for Payer: First Health Commercial |
$12,122.76
|
| Rate for Payer: Humana Commercial |
$10,846.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,463.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,417.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,828.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,229.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,570.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,552.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,658.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,955.85
|
| Rate for Payer: PHCS Commercial |
$12,250.37
|
| Rate for Payer: United Healthcare All Payer |
$11,229.50
|
|
|
HEAD/NECK HIP STEM #9*45MM
|
Facility
|
OP
|
$13,315.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.03 |
| Max. Negotiated Rate |
$12,782.98 |
| Rate for Payer: Aetna Commercial |
$10,253.01
|
| Rate for Payer: Anthem Medicaid |
$4,579.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,386.17
|
| Rate for Payer: Cash Price |
$6,657.80
|
| Rate for Payer: Cigna Commercial |
$11,051.95
|
| Rate for Payer: First Health Commercial |
$12,649.82
|
| Rate for Payer: Humana Commercial |
$11,318.26
|
| Rate for Payer: Humana KY Medicaid |
$4,579.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,625.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,918.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,826.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,994.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,717.73
|
| Rate for Payer: Ohio Health Group HMO |
$9,986.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,127.84
|
| Rate for Payer: PHCS Commercial |
$12,782.98
|
| Rate for Payer: United Healthcare All Payer |
$11,717.73
|
|
|
HEAD/NECK HIP STEM #9*45MM
|
Facility
|
IP
|
$13,315.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.03 |
| Max. Negotiated Rate |
$12,782.98 |
| Rate for Payer: Aetna Commercial |
$10,253.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,386.17
|
| Rate for Payer: Cash Price |
$6,657.80
|
| Rate for Payer: Cigna Commercial |
$11,051.95
|
| Rate for Payer: First Health Commercial |
$12,649.82
|
| Rate for Payer: Humana Commercial |
$11,318.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,918.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,826.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,994.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,717.73
|
| Rate for Payer: Ohio Health Group HMO |
$9,986.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,127.84
|
| Rate for Payer: PHCS Commercial |
$12,782.98
|
| Rate for Payer: United Healthcare All Payer |
$11,717.73
|
|
|
HEAD/NECK HIP STEM #9*55MM
|
Facility
|
IP
|
$15,299.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,988.94 |
| Max. Negotiated Rate |
$14,687.54 |
| Rate for Payer: Aetna Commercial |
$11,780.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,933.63
|
| Rate for Payer: Cash Price |
$7,649.76
|
| Rate for Payer: Cigna Commercial |
$12,698.60
|
| Rate for Payer: First Health Commercial |
$14,534.54
|
| Rate for Payer: Humana Commercial |
$13,004.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,545.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,291.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,589.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,463.58
|
| Rate for Payer: Ohio Health Group HMO |
$11,474.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,059.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,988.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,742.85
|
| Rate for Payer: PHCS Commercial |
$14,687.54
|
| Rate for Payer: United Healthcare All Payer |
$13,463.58
|
|
|
HEAD/NECK HIP STEM #9*55MM
|
Facility
|
OP
|
$15,299.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,988.94 |
| Max. Negotiated Rate |
$14,687.54 |
| Rate for Payer: Anthem Medicaid |
$5,261.50
|
| Rate for Payer: Aetna Commercial |
$11,780.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,933.63
|
| Rate for Payer: Cash Price |
$7,649.76
|
| Rate for Payer: Cigna Commercial |
$12,698.60
|
| Rate for Payer: First Health Commercial |
$14,534.54
|
| Rate for Payer: Humana Commercial |
$13,004.59
|
| Rate for Payer: Humana KY Medicaid |
$5,261.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,315.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,545.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,291.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,589.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,367.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,463.58
|
| Rate for Payer: Ohio Health Group HMO |
$11,474.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,059.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,988.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,742.85
|
| Rate for Payer: PHCS Commercial |
$14,687.54
|
| Rate for Payer: United Healthcare All Payer |
$13,463.58
|
|
|
HEAD OXINIUM FEM 40MM
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
HEAD OXINIUM FEM 40MM
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
HEAD OXINIUM MOD 44MM
|
Facility
|
IP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
HEAD OXINIUM MOD 44MM
|
Facility
|
OP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem Medicaid |
$5,406.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Humana KY Medicaid |
$5,406.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,461.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
HEAD RADIAL RHEAD LATERAL SZ 3
|
Facility
|
IP
|
$13,655.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.16 |
| Max. Negotiated Rate |
$13,108.85 |
| Rate for Payer: Aetna Commercial |
$10,514.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.94
|
| Rate for Payer: Cash Price |
$6,827.52
|
| Rate for Payer: Cigna Commercial |
$11,333.69
|
| Rate for Payer: First Health Commercial |
$12,972.30
|
| Rate for Payer: Humana Commercial |
$11,606.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.44
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,731.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,233.07
|
| Rate for Payer: PHCS Commercial |
$13,108.85
|
| Rate for Payer: United Healthcare All Payer |
$12,016.44
|
|
|
HEAD RADIAL RHEAD LATERAL SZ 3
|
Facility
|
OP
|
$13,655.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.16 |
| Max. Negotiated Rate |
$13,108.85 |
| Rate for Payer: Aetna Commercial |
$10,514.39
|
| Rate for Payer: Anthem Medicaid |
$4,695.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.94
|
| Rate for Payer: Cash Price |
$6,827.52
|
| Rate for Payer: Cigna Commercial |
$11,333.69
|
| Rate for Payer: First Health Commercial |
$12,972.30
|
| Rate for Payer: Humana Commercial |
$11,606.79
|
| Rate for Payer: Humana KY Medicaid |
$4,695.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.44
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,731.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,233.07
|
| Rate for Payer: PHCS Commercial |
$13,108.85
|
| Rate for Payer: United Healthcare All Payer |
$12,016.44
|
|
