|
HIP BALL 28MM +12 NECK LENGTH
|
Facility
|
OP
|
$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 Medicaid |
$1,559.07
|
| 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: Humana KY Medicaid |
$1,559.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.94
|
| 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: Molina Healthcare Medicaid |
$1,590.35
|
| 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
|
|
|
HIP BALL 28MM +15.5 NECK LENGT
|
Facility
|
IP
|
$4,293.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.08 |
| Max. Negotiated Rate |
$4,121.87 |
| Rate for Payer: Aetna Commercial |
$3,306.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,349.02
|
| Rate for Payer: Cash Price |
$2,146.81
|
| Rate for Payer: Cigna Commercial |
$3,563.70
|
| Rate for Payer: First Health Commercial |
$4,078.93
|
| Rate for Payer: Humana Commercial |
$3,649.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,520.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,168.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,778.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,220.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,434.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,735.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,962.59
|
| Rate for Payer: PHCS Commercial |
$4,121.87
|
| Rate for Payer: United Healthcare All Payer |
$3,778.38
|
|
|
HIP BALL 28MM +15.5 NECK LENGT
|
Facility
|
OP
|
$4,293.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.08 |
| Max. Negotiated Rate |
$4,121.87 |
| Rate for Payer: Aetna Commercial |
$3,306.08
|
| Rate for Payer: Anthem Medicaid |
$1,476.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,349.02
|
| Rate for Payer: Cash Price |
$2,146.81
|
| Rate for Payer: Cigna Commercial |
$3,563.70
|
| Rate for Payer: First Health Commercial |
$4,078.93
|
| Rate for Payer: Humana Commercial |
$3,649.57
|
| Rate for Payer: Humana KY Medicaid |
$1,476.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,491.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,520.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,168.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,506.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,778.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,220.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,434.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,735.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,962.59
|
| Rate for Payer: PHCS Commercial |
$4,121.87
|
| Rate for Payer: United Healthcare All Payer |
$3,778.38
|
|
|
HIP BALL 28MM +1.5 NECK LENGTH
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
HIP BALL 28MM +1.5 NECK LENGTH
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
HIP BALL 28MM +15 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 +15 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 +3 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 +3 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 +5 NECK LENGTH
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| 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 Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| 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: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
HIP BALL 28MM +5 NECK LENGTH
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| 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: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
HIP BALL 28MM +8.5 NECK LENGTH
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
HIP BALL 28MM +8.5 NECK LENGTH
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
HIP BALL 28MM +8 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 +8 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 CORE DEPCOMPRESSION
|
Facility
|
OP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76100807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| 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 |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 |
$5,814.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,323.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,015.35
|
| Rate for Payer: PHCS Commercial |
$6,977.88
|
| Rate for Payer: United Healthcare All Payer |
$6,396.39
|
|
|
HIP CORE DEPCOMPRESSION
|
Facility
|
IP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
76100807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,180.59 |
| 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 |
$5,814.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,323.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,015.35
|
| 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 |
$5,088.04 |
| Rate for Payer: Anthem Medicaid |
$1,040.00
|
| 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 |
$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 |
$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 |
$1,050.40
|
|
|
HIP CORE DEPCOMPRESSION(T
|
Facility
|
IP
|
$7,268.63
|
|
|
Service Code
|
HCPCS 27299
|
| Hospital Charge Code |
761T0807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,180.59 |
| 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 |
$5,814.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,323.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,015.35
|
| 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 |
$221.64 |
| 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 |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 |
$5,814.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,323.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,015.35
|
| 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
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
HIP FRAC FEM 10.MM X130MM STEM
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
HIP HINGE RAIL MOD LOWER
|
Facility
|
OP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem Medicaid |
$1,600.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Humana KY Medicaid |
$1,600.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,632.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
HIP HINGE RAIL MOD LOWER
|
Facility
|
IP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
HIP HINGE RAIL MOD UPPER
|
Facility
|
IP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
