|
HEAD LEGACY COCR 12/14 32MM +8
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HEAD LEGACY COCR 12/14 38MM +0
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM +0
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM +4
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM +4
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM -4
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM -4
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM +8
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM +8
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM -8
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LEGACY COCR 12/14 38MM -8
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HEAD LGY PR CR 12/14 28M +10.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HEAD LGY PR CR 12/14 28M +10.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HEAD/NECK HIP STEM #11*35MM
|
Facility
|
IP
|
$13,012.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,903.79 |
| Max. Negotiated Rate |
$12,492.13 |
| Rate for Payer: Aetna Commercial |
$10,019.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,149.86
|
| Rate for Payer: Cash Price |
$6,506.32
|
| Rate for Payer: Cigna Commercial |
$10,800.49
|
| Rate for Payer: First Health Commercial |
$12,362.01
|
| Rate for Payer: Humana Commercial |
$11,060.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,603.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,903.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,451.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,759.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,410.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,321.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,978.72
|
| Rate for Payer: PHCS Commercial |
$12,492.13
|
| Rate for Payer: United Healthcare All Payer |
$11,451.12
|
|
|
HEAD/NECK HIP STEM #11*35MM
|
Facility
|
OP
|
$13,012.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,903.79 |
| Max. Negotiated Rate |
$12,492.13 |
| Rate for Payer: Aetna Commercial |
$10,019.73
|
| Rate for Payer: Anthem Medicaid |
$4,475.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,149.86
|
| Rate for Payer: Cash Price |
$6,506.32
|
| Rate for Payer: Cigna Commercial |
$10,800.49
|
| Rate for Payer: First Health Commercial |
$12,362.01
|
| Rate for Payer: Humana Commercial |
$11,060.74
|
| Rate for Payer: Humana KY Medicaid |
$4,475.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,520.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,603.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,903.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,564.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,451.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,759.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,410.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,321.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,978.72
|
| Rate for Payer: PHCS Commercial |
$12,492.13
|
| Rate for Payer: United Healthcare All Payer |
$11,451.12
|
|
|
HEAD/NECK HIP STEM # 5
|
Facility
|
IP
|
$16,151.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,845.36 |
| Max. Negotiated Rate |
$15,505.15 |
| Rate for Payer: Aetna Commercial |
$12,436.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,597.94
|
| Rate for Payer: Cash Price |
$8,075.60
|
| Rate for Payer: Cigna Commercial |
$13,405.50
|
| Rate for Payer: First Health Commercial |
$15,343.64
|
| Rate for Payer: Humana Commercial |
$13,728.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,243.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,919.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.06
|
| Rate for Payer: Ohio Health Group HMO |
$12,113.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,920.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,051.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,144.33
|
| Rate for Payer: PHCS Commercial |
$15,505.15
|
| Rate for Payer: United Healthcare All Payer |
$14,213.06
|
|
|
HEAD/NECK HIP STEM # 5
|
Facility
|
OP
|
$16,151.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,845.36 |
| Max. Negotiated Rate |
$15,505.15 |
| Rate for Payer: Aetna Commercial |
$12,436.42
|
| Rate for Payer: Anthem Medicaid |
$5,554.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,597.94
|
| Rate for Payer: Cash Price |
$8,075.60
|
| Rate for Payer: Cigna Commercial |
$13,405.50
|
| Rate for Payer: First Health Commercial |
$15,343.64
|
| Rate for Payer: Humana Commercial |
$13,728.52
|
| Rate for Payer: Humana KY Medicaid |
$5,554.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,610.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,243.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,919.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,665.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.06
|
| Rate for Payer: Ohio Health Group HMO |
$12,113.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,920.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,051.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,144.33
|
| Rate for Payer: PHCS Commercial |
$15,505.15
|
| Rate for Payer: United Healthcare All Payer |
$14,213.06
|
|
|
HEAD/NECK HIP STEM #7*35MM
|
Facility
|
OP
|
$16,550.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,965.24 |
| Max. Negotiated Rate |
$15,888.77 |
| Rate for Payer: Aetna Commercial |
$12,744.12
|
| Rate for Payer: Anthem Medicaid |
$5,691.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,909.62
|
| Rate for Payer: Cash Price |
$8,275.40
|
| Rate for Payer: Cigna Commercial |
$13,737.16
|
| Rate for Payer: First Health Commercial |
$15,723.26
|
| Rate for Payer: Humana Commercial |
$14,068.18
|
| Rate for Payer: Humana KY Medicaid |
$5,691.82
|
| Rate for Payer: Kentucky WC Medicaid |
$5,749.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,571.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,214.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,965.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,806.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,564.70
|
| Rate for Payer: Ohio Health Group HMO |
$12,413.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,240.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,399.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,420.05
|
| Rate for Payer: PHCS Commercial |
$15,888.77
|
| Rate for Payer: United Healthcare All Payer |
$14,564.70
|
|
|
HEAD/NECK HIP STEM #7*35MM
|
Facility
|
IP
|
$16,550.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,965.24 |
| Max. Negotiated Rate |
$15,888.77 |
| Rate for Payer: Aetna Commercial |
$12,744.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,909.62
|
| Rate for Payer: Cash Price |
$8,275.40
|
| Rate for Payer: Cigna Commercial |
$13,737.16
|
| Rate for Payer: First Health Commercial |
$15,723.26
|
| Rate for Payer: Humana Commercial |
$14,068.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,571.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,214.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,965.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,564.70
|
| Rate for Payer: Ohio Health Group HMO |
$12,413.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,240.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,399.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,420.05
|
| Rate for Payer: PHCS Commercial |
$15,888.77
|
| Rate for Payer: United Healthcare All Payer |
$14,564.70
|
|
|
HEAD/NECK HIP STEM #9*35MM
|
Facility
|
IP
|
$13,012.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,903.79 |
| Max. Negotiated Rate |
$12,492.13 |
| Rate for Payer: Aetna Commercial |
$10,019.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,149.86
|
| Rate for Payer: Cash Price |
$6,506.32
|
| Rate for Payer: Cigna Commercial |
$10,800.49
|
| Rate for Payer: First Health Commercial |
$12,362.01
|
| Rate for Payer: Humana Commercial |
$11,060.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,603.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,903.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,451.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,759.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,410.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,321.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,978.72
|
| Rate for Payer: PHCS Commercial |
$12,492.13
|
| Rate for Payer: United Healthcare All Payer |
$11,451.12
|
|
|
HEAD/NECK HIP STEM #9*35MM
|
Facility
|
OP
|
$13,012.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,903.79 |
| Max. Negotiated Rate |
$12,492.13 |
| Rate for Payer: Aetna Commercial |
$10,019.73
|
| Rate for Payer: Anthem Medicaid |
$4,475.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,149.86
|
| Rate for Payer: Cash Price |
$6,506.32
|
| Rate for Payer: Cigna Commercial |
$10,800.49
|
| Rate for Payer: First Health Commercial |
$12,362.01
|
| Rate for Payer: Humana Commercial |
$11,060.74
|
| Rate for Payer: Humana KY Medicaid |
$4,475.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,520.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,603.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,903.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,564.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,451.12
|
| Rate for Payer: Ohio Health Group HMO |
$9,759.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,410.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,321.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,978.72
|
| Rate for Payer: PHCS Commercial |
$12,492.13
|
| Rate for Payer: United Healthcare All Payer |
$11,451.12
|
|
|
HEAD/NECK HIP STEM #9*45MM
|
Facility
|
OP
|
$13,570.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.14 |
| Max. Negotiated Rate |
$13,027.66 |
| Rate for Payer: Aetna Commercial |
$10,449.27
|
| Rate for Payer: Anthem Medicaid |
$4,666.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,584.97
|
| Rate for Payer: Cash Price |
$6,785.24
|
| Rate for Payer: Cigna Commercial |
$11,263.50
|
| Rate for Payer: First Health Commercial |
$12,891.96
|
| Rate for Payer: Humana Commercial |
$11,534.91
|
| Rate for Payer: Humana KY Medicaid |
$4,666.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,714.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,127.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,015.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,760.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,942.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,177.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,856.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,806.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,363.63
|
| Rate for Payer: PHCS Commercial |
$13,027.66
|
| Rate for Payer: United Healthcare All Payer |
$11,942.02
|
|
|
HEAD/NECK HIP STEM #9*45MM
|
Facility
|
IP
|
$13,570.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.14 |
| Max. Negotiated Rate |
$13,027.66 |
| Rate for Payer: Aetna Commercial |
$10,449.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,584.97
|
| Rate for Payer: Cash Price |
$6,785.24
|
| Rate for Payer: Cigna Commercial |
$11,263.50
|
| Rate for Payer: First Health Commercial |
$12,891.96
|
| Rate for Payer: Humana Commercial |
$11,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,127.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,015.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,942.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,177.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,856.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,806.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,363.63
|
| Rate for Payer: PHCS Commercial |
$13,027.66
|
| Rate for Payer: United Healthcare All Payer |
$11,942.02
|
|
|
HEAD/NECK HIP STEM #9*55MM
|
Facility
|
OP
|
$15,807.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,742.35 |
| Max. Negotiated Rate |
$15,175.53 |
| Rate for Payer: Aetna Commercial |
$12,172.04
|
| Rate for Payer: Anthem Medicaid |
$5,436.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,330.12
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cigna Commercial |
$13,120.51
|
| Rate for Payer: First Health Commercial |
$15,017.45
|
| Rate for Payer: Humana Commercial |
$13,436.66
|
| Rate for Payer: Humana KY Medicaid |
$5,436.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,491.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,962.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,666.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,742.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,545.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,910.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,855.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,646.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,752.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,907.41
|
| Rate for Payer: PHCS Commercial |
$15,175.53
|
| Rate for Payer: United Healthcare All Payer |
$13,910.90
|
|
|
HEAD/NECK HIP STEM #9*55MM
|
Facility
|
IP
|
$15,807.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,742.35 |
| Max. Negotiated Rate |
$15,175.53 |
| Rate for Payer: Aetna Commercial |
$12,172.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,330.12
|
| Rate for Payer: Cash Price |
$7,903.92
|
| Rate for Payer: Cigna Commercial |
$13,120.51
|
| Rate for Payer: First Health Commercial |
$15,017.45
|
| Rate for Payer: Humana Commercial |
$13,436.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,962.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,666.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,742.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,910.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,855.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,646.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,752.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,907.41
|
| Rate for Payer: PHCS Commercial |
$15,175.53
|
| Rate for Payer: United Healthcare All Payer |
$13,910.90
|
|
