|
HIP BALL 28MM +8.5 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 +8.5 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 +8 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 +8 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 CORE DEPCOMPRESSION
|
Facility
|
IP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76100807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$944.92 |
| Max. Negotiated Rate |
$6,977.88 |
| Rate for Payer: Aetna Commercial |
$5,596.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.53
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cigna Commercial |
$6,032.96
|
| Rate for Payer: First Health Commercial |
$6,905.20
|
| Rate for Payer: Humana Commercial |
$6,178.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.28
|
| Rate for Payer: PHCS Commercial |
$6,977.88
|
| Rate for Payer: United Healthcare All Payer |
$6,396.39
|
|
|
HIP CORE DEPCOMPRESSION
|
Professional
|
Both
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76100807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$7,268.63 |
| Rate for Payer: Anthem Medicaid |
$800.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,268.63
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$800.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$816.00
|
| Rate for Payer: Molina Healthcare Passport |
$800.00
|
| Rate for Payer: Multiplan PHCS |
$4,361.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,088.04
|
| Rate for Payer: UHCCP Medicaid |
$2,544.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$808.00
|
|
|
HIP CORE DEPCOMPRESSION
|
Facility
|
OP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76100807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$6,977.88 |
| Rate for Payer: Aetna Commercial |
$5,596.85
|
| Rate for Payer: Anthem Medicaid |
$2,499.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cigna Commercial |
$6,032.96
|
| Rate for Payer: First Health Commercial |
$6,905.20
|
| Rate for Payer: Humana Commercial |
$6,178.34
|
| Rate for Payer: Humana KY Medicaid |
$2,499.68
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,525.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.28
|
| Rate for Payer: PHCS Commercial |
$6,977.88
|
| Rate for Payer: United Healthcare All Payer |
$6,396.39
|
|
|
HIP CORE DEPCOMPRESSION(T
|
Facility
|
OP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
761T0807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$6,977.88 |
| Rate for Payer: Aetna Commercial |
$5,596.85
|
| Rate for Payer: Anthem Medicaid |
$2,499.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cigna Commercial |
$6,032.96
|
| Rate for Payer: First Health Commercial |
$6,905.20
|
| Rate for Payer: Humana Commercial |
$6,178.34
|
| Rate for Payer: Humana KY Medicaid |
$2,499.68
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,525.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.28
|
| Rate for Payer: PHCS Commercial |
$6,977.88
|
| Rate for Payer: United Healthcare All Payer |
$6,396.39
|
|
|
HIP CORE DEPCOMPRESSION(T
|
Facility
|
IP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
761T0807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$944.92 |
| Max. Negotiated Rate |
$6,977.88 |
| Rate for Payer: Aetna Commercial |
$5,596.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.53
|
| Rate for Payer: Cash Price |
$3,634.32
|
| Rate for Payer: Cigna Commercial |
$6,032.96
|
| Rate for Payer: First Health Commercial |
$6,905.20
|
| Rate for Payer: Humana Commercial |
$6,178.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.28
|
| Rate for Payer: PHCS Commercial |
$6,977.88
|
| Rate for Payer: United Healthcare All Payer |
$6,396.39
|
|
|
HIP FRAC FEM 10.MM X130MM STEM
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
HIP FRAC FEM 10.MM X130MM STEM
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
HIP HINGE RAIL MOD LOWER
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem Medicaid |
$1,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Humana KY Medicaid |
$1,608.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,625.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,641.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
HIP HINGE RAIL MOD LOWER
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
HIP HINGE RAIL MOD UPPER
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
HIP HINGE RAIL MOD UPPER
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem Medicaid |
$1,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Humana KY Medicaid |
$1,608.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,625.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,641.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
HIP HINGE SM RAIL MOD UPPER
|
Facility
|
IP
|
$4,148.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.34 |
| Max. Negotiated Rate |
$3,982.85 |
| Rate for Payer: Aetna Commercial |
$3,194.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.06
|
| Rate for Payer: Cash Price |
$2,074.40
|
| Rate for Payer: Cigna Commercial |
$3,443.50
|
| Rate for Payer: First Health Commercial |
$3,941.36
|
| Rate for Payer: Humana Commercial |
$3,526.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,650.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.13
|
| Rate for Payer: PHCS Commercial |
$3,982.85
|
| Rate for Payer: United Healthcare All Payer |
$3,650.94
|
|
|
HIP HINGE SM RAIL MOD UPPER
|
Facility
|
OP
|
$4,148.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.34 |
| Max. Negotiated Rate |
$3,982.85 |
| Rate for Payer: Aetna Commercial |
$3,194.58
|
| Rate for Payer: Anthem Medicaid |
$1,426.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.06
|
| Rate for Payer: Cash Price |
$2,074.40
|
| Rate for Payer: Cigna Commercial |
$3,443.50
|
| Rate for Payer: First Health Commercial |
$3,941.36
|
| Rate for Payer: Humana Commercial |
$3,526.48
|
| Rate for Payer: Humana KY Medicaid |
$1,426.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,650.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.13
|
| Rate for Payer: PHCS Commercial |
$3,982.85
|
| Rate for Payer: United Healthcare All Payer |
$3,650.94
|
|
|
HIP LT 2-3 VIEWS
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
32000095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Anthem Medicaid |
$30.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$64.67
|
| Rate for Payer: Humana Medicaid |
$30.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.42
|
| Rate for Payer: Molina Healthcare Passport |
$30.80
|
| Rate for Payer: Multiplan PHCS |
$367.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$428.40
|
| Rate for Payer: UHCCP Medicaid |
$214.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.11
|
|
|
HIP LT 2-3 VIEWS
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
32000095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$587.52 |
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Anthem Medicaid |
$210.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$477.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$507.96
|
| Rate for Payer: First Health Commercial |
$581.40
|
| Rate for Payer: Humana Commercial |
$520.20
|
| Rate for Payer: Humana KY Medicaid |
$210.47
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$212.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$451.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$538.56
|
| Rate for Payer: Ohio Health Group HMO |
$459.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.72
|
| Rate for Payer: PHCS Commercial |
$587.52
|
| Rate for Payer: United Healthcare All Payer |
$538.56
|
|
|
HIP LT 2-3 VIEWS
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
32000095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$587.52 |
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$477.36
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$507.96
|
| Rate for Payer: First Health Commercial |
$581.40
|
| Rate for Payer: Humana Commercial |
$520.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$451.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$538.56
|
| Rate for Payer: Ohio Health Group HMO |
$459.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.72
|
| Rate for Payer: PHCS Commercial |
$587.52
|
| Rate for Payer: United Healthcare All Payer |
$538.56
|
|
|
HIP LT 2-3 VIEWS(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
320P0095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Anthem Medicaid |
$30.80
|
| 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 |
$64.67
|
| Rate for Payer: Humana Medicaid |
$30.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.42
|
| Rate for Payer: Molina Healthcare Passport |
$30.80
|
| 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 |
$31.11
|
|
|
HIP LT 2-3 VIEWS(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
320T0095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
HIP LT 2-3 VIEWS(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
320T0095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC
|
Facility
|
IP
|
$35,026.75
|
|
|
Service Code
|
MSDRG 521
|
| Min. Negotiated Rate |
$23,768.15 |
| Max. Negotiated Rate |
$35,026.75 |
| Rate for Payer: Anthem Medicaid |
$23,768.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,019.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35,026.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,775.80
|
| Rate for Payer: Humana KY Medicaid |
$23,768.15
|
| Rate for Payer: Humana Medicare Advantage |
$25,019.11
|
| Rate for Payer: Kentucky WC Medicaid |
$24,005.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,022.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,243.52
|
|
|
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC
|
Facility
|
IP
|
$24,708.96
|
|
|
Service Code
|
MSDRG 522
|
| Min. Negotiated Rate |
$16,766.80 |
| Max. Negotiated Rate |
$24,708.96 |
| Rate for Payer: Anthem Medicaid |
$16,766.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,649.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,708.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,826.50
|
| Rate for Payer: Humana KY Medicaid |
$16,766.80
|
| Rate for Payer: Humana Medicare Advantage |
$17,649.26
|
| Rate for Payer: Kentucky WC Medicaid |
$16,934.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,179.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,102.13
|
|
