|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC
|
Facility
|
IP
|
$24,272.58
|
|
|
Service Code
|
MSDRG 481
|
| Min. Negotiated Rate |
$16,470.68 |
| Max. Negotiated Rate |
$24,272.58 |
| Rate for Payer: Anthem Medicaid |
$16,470.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,337.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,272.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,405.71
|
| Rate for Payer: Humana KY Medicaid |
$16,470.68
|
| Rate for Payer: Humana Medicare Advantage |
$17,337.56
|
| Rate for Payer: Kentucky WC Medicaid |
$16,635.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,805.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,800.10
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC
|
Facility
|
IP
|
$34,496.84
|
|
|
Service Code
|
MSDRG 480
|
| Min. Negotiated Rate |
$23,408.57 |
| Max. Negotiated Rate |
$34,496.84 |
| Rate for Payer: Anthem Medicaid |
$23,408.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,640.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34,496.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,264.81
|
| Rate for Payer: Humana KY Medicaid |
$23,408.57
|
| Rate for Payer: Humana Medicare Advantage |
$24,640.60
|
| Rate for Payer: Kentucky WC Medicaid |
$23,642.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,568.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,876.74
|
|
|
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC
|
Facility
|
IP
|
$18,581.43
|
|
|
Service Code
|
MSDRG 482
|
| Min. Negotiated Rate |
$12,608.83 |
| Max. Negotiated Rate |
$18,581.43 |
| Rate for Payer: Anthem Medicaid |
$12,608.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,272.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,581.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,917.81
|
| Rate for Payer: Humana KY Medicaid |
$12,608.83
|
| Rate for Payer: Humana Medicare Advantage |
$13,272.45
|
| Rate for Payer: Kentucky WC Medicaid |
$12,734.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,926.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,861.00
|
|
|
HIP AP-LT (1V)
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
32000094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$469.00 |
| Rate for Payer: Anthem Medicaid |
$22.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.00
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$46.37
|
| Rate for Payer: Humana Medicaid |
$22.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.82
|
| Rate for Payer: Molina Healthcare Passport |
$22.37
|
| Rate for Payer: Multiplan PHCS |
$281.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$328.30
|
| Rate for Payer: UHCCP Medicaid |
$164.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.59
|
|
|
HIP AP-LT (1V)
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
32000094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem Medicaid |
$161.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Humana KY Medicaid |
$161.29
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$162.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.39
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
HIP AP-LT (1V)
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
32000094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.39
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
HIP AP-LT (1V)(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
320P0094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Anthem Medicaid |
$22.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$46.37
|
| Rate for Payer: Humana Medicaid |
$22.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.82
|
| Rate for Payer: Molina Healthcare Passport |
$22.37
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.59
|
|
|
HIP AP-LT (1V)(T
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
320T0094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
HIP AP-LT (1V)(T
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
320T0094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$89.07
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$89.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
HIP BALL 28MM +0 NECK LENGTH
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
HIP BALL 28MM +0 NECK LENGTH
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
HIP BALL 28MM +11 NECK LENGTH
|
Facility
|
OP
|
$4,219.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.54 |
| Max. Negotiated Rate |
$4,050.76 |
| Rate for Payer: Aetna Commercial |
$3,249.05
|
| Rate for Payer: Anthem Medicaid |
$1,451.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,291.24
|
| Rate for Payer: Cash Price |
$2,109.77
|
| Rate for Payer: Cigna Commercial |
$3,502.22
|
| Rate for Payer: First Health Commercial |
$4,008.56
|
| Rate for Payer: Humana Commercial |
$3,586.61
|
| Rate for Payer: Humana KY Medicaid |
$1,451.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,114.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,480.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,713.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,164.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.06
|
| Rate for Payer: PHCS Commercial |
$4,050.76
|
| Rate for Payer: United Healthcare All Payer |
$3,713.20
|
|
|
HIP BALL 28MM +11 NECK LENGTH
|
Facility
|
IP
|
$4,219.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.54 |
| Max. Negotiated Rate |
$4,050.76 |
| Rate for Payer: Aetna Commercial |
$3,249.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,291.24
|
| Rate for Payer: Cash Price |
$2,109.77
|
| Rate for Payer: Cigna Commercial |
$3,502.22
|
| Rate for Payer: First Health Commercial |
$4,008.56
|
| Rate for Payer: Humana Commercial |
$3,586.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,460.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,114.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,713.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,164.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.06
|
| Rate for Payer: PHCS Commercial |
$4,050.76
|
| Rate for Payer: United Healthcare All Payer |
$3,713.20
|
|
|
HIP BALL 28MM +12 NECK LENGTH
|
Facility
|
OP
|
$4,564.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$4,382.02 |
| Rate for Payer: Aetna Commercial |
$3,514.74
|
| Rate for Payer: Anthem Medicaid |
$1,569.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,560.39
|
| Rate for Payer: Cash Price |
$2,282.30
|
| Rate for Payer: Cigna Commercial |
$3,788.62
|
| Rate for Payer: First Health Commercial |
$4,336.37
|
| Rate for Payer: Humana Commercial |
$3,879.91
|
| Rate for Payer: Humana KY Medicaid |
$1,569.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,742.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,369.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,601.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,016.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,423.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.03
|
| Rate for Payer: PHCS Commercial |
$4,382.02
|
| Rate for Payer: United Healthcare All Payer |
$4,016.85
|
|
|
HIP BALL 28MM +12 NECK LENGTH
|
Facility
|
IP
|
$4,564.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$4,382.02 |
| Rate for Payer: Aetna Commercial |
$3,514.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,560.39
|
| Rate for Payer: Cash Price |
$2,282.30
|
| Rate for Payer: Cigna Commercial |
$3,788.62
|
| Rate for Payer: First Health Commercial |
$4,336.37
|
| Rate for Payer: Humana Commercial |
$3,879.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,742.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,369.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,016.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,423.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.03
|
| Rate for Payer: PHCS Commercial |
$4,382.02
|
| Rate for Payer: United Healthcare All Payer |
$4,016.85
|
|
|
HIP BALL 28MM +15.5 NECK LENGT
|
Facility
|
IP
|
$4,340.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$4,167.07 |
| Rate for Payer: Aetna Commercial |
$3,342.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,385.75
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Cigna Commercial |
$3,602.78
|
| Rate for Payer: First Health Commercial |
$4,123.66
|
| Rate for Payer: Humana Commercial |
$3,689.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,559.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,203.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,819.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.62
|
| Rate for Payer: PHCS Commercial |
$4,167.07
|
| Rate for Payer: United Healthcare All Payer |
$3,819.82
|
|
|
HIP BALL 28MM +15.5 NECK LENGT
|
Facility
|
OP
|
$4,340.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.29 |
| Max. Negotiated Rate |
$4,167.07 |
| Rate for Payer: Aetna Commercial |
$3,342.34
|
| Rate for Payer: Anthem Medicaid |
$1,492.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,385.75
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Cigna Commercial |
$3,602.78
|
| Rate for Payer: First Health Commercial |
$4,123.66
|
| Rate for Payer: Humana Commercial |
$3,689.60
|
| Rate for Payer: Humana KY Medicaid |
$1,492.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,559.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,203.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,522.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,819.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.62
|
| Rate for Payer: PHCS Commercial |
$4,167.07
|
| Rate for Payer: United Healthcare All Payer |
$3,819.82
|
|
|
HIP BALL 28MM +1.5 NECK LENGTH
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
HIP BALL 28MM +1.5 NECK LENGTH
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
HIP BALL 28MM +15 NECK LENGTH
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
HIP BALL 28MM +15 NECK LENGTH
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
HIP BALL 28MM +3 NECK LENGTH
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
HIP BALL 28MM +3 NECK LENGTH
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
HIP BALL 28MM +5 NECK LENGTH
|
Facility
|
OP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,569.04
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,569.04
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,585.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
|
|
HIP BALL 28MM +5 NECK LENGTH
|
Facility
|
IP
|
$4,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.12 |
| Max. Negotiated Rate |
$4,380.00 |
| Rate for Payer: Aetna Commercial |
$3,513.12
|
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,281.25
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$3,786.88
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: First Health Commercial |
$4,334.38
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana Commercial |
$3,878.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,741.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,367.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,015.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.38
|
| Rate for Payer: PHCS Commercial |
$4,380.00
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,015.00
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
