|
SELF CENT HEAD 41MM +5
|
Facility
|
IP
|
$8,588.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.56 |
| Max. Negotiated Rate |
$8,245.34 |
| Rate for Payer: Aetna Commercial |
$6,613.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,699.34
|
| Rate for Payer: Cash Price |
$4,294.45
|
| Rate for Payer: Cigna Commercial |
$7,128.79
|
| Rate for Payer: First Health Commercial |
$8,159.46
|
| Rate for Payer: Humana Commercial |
$7,300.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,042.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,338.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,558.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,441.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,662.56
|
| Rate for Payer: PHCS Commercial |
$8,245.34
|
| Rate for Payer: United Healthcare All Payer |
$7,558.23
|
|
|
SELF CENT HEAD 50MM +5
|
Facility
|
OP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem Medicaid |
$2,265.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Humana KY Medicaid |
$2,265.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,288.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,311.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
SELF CENT HEAD 50MM +5
|
Facility
|
IP
|
$6,588.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.53 |
| Max. Negotiated Rate |
$6,325.15 |
| Rate for Payer: Aetna Commercial |
$5,073.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,139.19
|
| Rate for Payer: Cash Price |
$3,294.35
|
| Rate for Payer: Cigna Commercial |
$5,468.62
|
| Rate for Payer: First Health Commercial |
$6,259.26
|
| Rate for Payer: Humana Commercial |
$5,600.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,402.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,862.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,976.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,941.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,042.50
|
| Rate for Payer: PHCS Commercial |
$6,325.15
|
| Rate for Payer: United Healthcare All Payer |
$5,798.06
|
|
|
SELF CENT HIP COMP 41MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 41MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 42MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 42MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 43MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 43MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 44MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 44MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 44MM 32MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 44MM 32MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 45MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 45MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 46MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 46MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 47MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 47MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 48MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 48MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 49MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 49MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 50MM 28MM
|
Facility
|
OP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem Medicaid |
$3,388.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Humana KY Medicaid |
$3,388.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,422.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,456.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
|
SELF CENT HIP COMP 50MM 28MM
|
Facility
|
IP
|
$9,851.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.73 |
| Max. Negotiated Rate |
$9,457.73 |
| Rate for Payer: Aetna Commercial |
$7,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,684.40
|
| Rate for Payer: Cash Price |
$4,925.90
|
| Rate for Payer: Cigna Commercial |
$8,176.99
|
| Rate for Payer: First Health Commercial |
$9,359.21
|
| Rate for Payer: Humana Commercial |
$8,374.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,078.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,270.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,955.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,669.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,388.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,970.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,054.06
|
| Rate for Payer: PHCS Commercial |
$9,457.73
|
| Rate for Payer: United Healthcare All Payer |
$8,669.58
|
|
