|
HINGE NXGN ROTART SUR F 17 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR F 20 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR F 20 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR F 23 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR F 23 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR F 26 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR F 26 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HIP 2-3 VIEWS
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
32000095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$612.48 |
| Rate for Payer: Aetna Commercial |
$491.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$497.64
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$529.54
|
| Rate for Payer: First Health Commercial |
$606.10
|
| Rate for Payer: Humana Commercial |
$542.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$561.44
|
| Rate for Payer: Ohio Health Group HMO |
$478.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.22
|
| Rate for Payer: PHCS Commercial |
$612.48
|
| Rate for Payer: United Healthcare All Payer |
$561.44
|
|
|
HIP 2-3 VIEWS
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
32000095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$382.80 |
| Rate for Payer: Ambetter Exchange |
$42.85
|
| Rate for Payer: Anthem Medicaid |
$30.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$42.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.42
|
| Rate for Payer: Molina Healthcare Passport |
$30.80
|
| Rate for Payer: Multiplan PHCS |
$382.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.70
|
| Rate for Payer: UHCCP Medicaid |
$223.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.85
|
|
|
HIP 2-3 VIEWS
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
32000095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$612.48 |
| Rate for Payer: Aetna Commercial |
$491.26
|
| Rate for Payer: Anthem Medicaid |
$219.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$497.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$529.54
|
| Rate for Payer: First Health Commercial |
$606.10
|
| Rate for Payer: Humana Commercial |
$542.30
|
| Rate for Payer: Humana KY Medicaid |
$219.41
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$221.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$561.44
|
| Rate for Payer: Ohio Health Group HMO |
$478.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.22
|
| Rate for Payer: PHCS Commercial |
$612.48
|
| Rate for Payer: United Healthcare All Payer |
$561.44
|
|
|
HIP 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 |
$126.00 |
| Rate for Payer: Ambetter Exchange |
$42.85
|
| Rate for Payer: Anthem Medicaid |
$30.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$42.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.85
|
| 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 |
$55.70
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.85
|
|
|
HIP 2-3 VIEWS(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
320T0095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
HIP 2-3 VIEWS(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 73502
|
| Hospital Charge Code |
320T0095
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
HIP ABD TEND REP/TEND ALLOGRFT
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76102996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Anthem Medicaid |
$1,040.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$1,040.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,060.80
|
| Rate for Payer: Molina Healthcare Passport |
$1,040.00
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,050.40
|
|
|
HIP AP-LT (1V)
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
32000094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem Medicaid |
$167.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Humana KY Medicaid |
$167.14
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$168.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.34
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
HIP AP-LT (1V)
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
32000094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$291.60 |
| Rate for Payer: Ambetter Exchange |
$30.06
|
| Rate for Payer: Anthem Medicaid |
$22.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.07
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.82
|
| Rate for Payer: Molina Healthcare Passport |
$22.37
|
| Rate for Payer: Multiplan PHCS |
$291.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.08
|
| Rate for Payer: UHCCP Medicaid |
$170.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.06
|
|
|
HIP AP-LT (1V)
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
32000094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.08
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.34
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
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 |
$126.00 |
| Rate for Payer: Ambetter Exchange |
$30.06
|
| Rate for Payer: Anthem Medicaid |
$22.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.07
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.06
|
| 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 |
$39.08
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.06
|
|
|
HIP AP-LT (1V)(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
320T0094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
HIP AP-LT (1V)(T
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 73501
|
| Hospital Charge Code |
320T0094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
HIP BALL 28MM +0 NECK LENGTH
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
HIP BALL 28MM +0 NECK LENGTH
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
HIP BALL 28MM +11 NECK LENGTH
|
Facility
|
IP
|
$4,163.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.14 |
| Max. Negotiated Rate |
$3,997.24 |
| Rate for Payer: Aetna Commercial |
$3,206.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,247.76
|
| Rate for Payer: Cash Price |
$2,081.89
|
| Rate for Payer: Cigna Commercial |
$3,455.95
|
| Rate for Payer: First Health Commercial |
$3,955.60
|
| Rate for Payer: Humana Commercial |
$3,539.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,072.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,122.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,331.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,622.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.02
|
| Rate for Payer: PHCS Commercial |
$3,997.24
|
| Rate for Payer: United Healthcare All Payer |
$3,664.14
|
|
|
HIP BALL 28MM +11 NECK LENGTH
|
Facility
|
OP
|
$4,163.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.14 |
| Max. Negotiated Rate |
$3,997.24 |
| Rate for Payer: Aetna Commercial |
$3,206.12
|
| Rate for Payer: Anthem Medicaid |
$1,431.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,247.76
|
| Rate for Payer: Cash Price |
$2,081.89
|
| Rate for Payer: Cigna Commercial |
$3,455.95
|
| Rate for Payer: First Health Commercial |
$3,955.60
|
| Rate for Payer: Humana Commercial |
$3,539.22
|
| Rate for Payer: Humana KY Medicaid |
$1,431.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,446.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,072.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,460.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,122.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,331.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,622.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.02
|
| Rate for Payer: PHCS Commercial |
$3,997.24
|
| Rate for Payer: United Healthcare All Payer |
$3,664.14
|
|
|
HIP BALL 28MM +12 NECK LENGTH
|
Facility
|
IP
|
$4,533.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.05 |
| Max. Negotiated Rate |
$4,352.16 |
| Rate for Payer: Aetna Commercial |
$3,490.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,536.13
|
| Rate for Payer: Cash Price |
$2,266.75
|
| Rate for Payer: Cigna Commercial |
$3,762.80
|
| Rate for Payer: First Health Commercial |
$4,306.82
|
| Rate for Payer: Humana Commercial |
$3,853.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,717.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,345.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,360.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,989.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,400.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,626.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,944.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,128.11
|
| Rate for Payer: PHCS Commercial |
$4,352.16
|
| Rate for Payer: United Healthcare All Payer |
$3,989.48
|
|
