|
SELF CENT HIP COMP 51MM 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 51MM 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 52MM 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 52MM 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 53MM 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 53MM 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 54MM 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 54MM 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 55MM 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 55MM 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 56MM 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 56MM 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 57MM 28MM
|
Facility
|
IP
|
$9,541.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.40 |
| Max. Negotiated Rate |
$9,159.89 |
| Rate for Payer: Aetna Commercial |
$7,346.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,442.41
|
| Rate for Payer: Cash Price |
$4,770.77
|
| Rate for Payer: Cigna Commercial |
$7,919.49
|
| Rate for Payer: First Health Commercial |
$9,064.47
|
| Rate for Payer: Humana Commercial |
$8,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,824.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,041.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,862.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,396.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,156.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,908.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,957.88
|
| Rate for Payer: PHCS Commercial |
$9,159.89
|
| Rate for Payer: United Healthcare All Payer |
$8,396.56
|
|
|
SELF CENT HIP COMP 57MM 28MM
|
Facility
|
OP
|
$9,541.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.40 |
| Max. Negotiated Rate |
$9,159.89 |
| Rate for Payer: Aetna Commercial |
$7,346.99
|
| Rate for Payer: Anthem Medicaid |
$3,281.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,442.41
|
| Rate for Payer: Cash Price |
$4,770.77
|
| Rate for Payer: Cigna Commercial |
$7,919.49
|
| Rate for Payer: First Health Commercial |
$9,064.47
|
| Rate for Payer: Humana Commercial |
$8,110.32
|
| Rate for Payer: Humana KY Medicaid |
$3,281.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,314.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,824.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,041.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,862.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,347.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,396.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,156.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,908.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,957.88
|
| Rate for Payer: PHCS Commercial |
$9,159.89
|
| Rate for Payer: United Healthcare All Payer |
$8,396.56
|
|
|
SELF CENT HIP COMP 59MM 28MM
|
Facility
|
IP
|
$7,840.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.28 |
| Max. Negotiated Rate |
$7,527.02 |
| Rate for Payer: Aetna Commercial |
$6,037.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,115.71
|
| Rate for Payer: Cash Price |
$3,920.32
|
| Rate for Payer: Cigna Commercial |
$6,507.74
|
| Rate for Payer: First Health Commercial |
$7,448.62
|
| Rate for Payer: Humana Commercial |
$6,664.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,429.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,786.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,352.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,899.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,880.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,568.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,019.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,430.60
|
| Rate for Payer: PHCS Commercial |
$7,527.02
|
| Rate for Payer: United Healthcare All Payer |
$6,899.77
|
|
|
SELF CENT HIP COMP 59MM 28MM
|
Facility
|
OP
|
$7,840.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.28 |
| Max. Negotiated Rate |
$7,527.02 |
| Rate for Payer: Aetna Commercial |
$6,037.30
|
| Rate for Payer: Anthem Medicaid |
$2,696.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,115.71
|
| Rate for Payer: Cash Price |
$3,920.32
|
| Rate for Payer: Cigna Commercial |
$6,507.74
|
| Rate for Payer: First Health Commercial |
$7,448.62
|
| Rate for Payer: Humana Commercial |
$6,664.55
|
| Rate for Payer: Humana KY Medicaid |
$2,696.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,723.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,429.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,786.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,352.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,750.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,899.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,880.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,568.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,019.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,430.60
|
| Rate for Payer: PHCS Commercial |
$7,527.02
|
| Rate for Payer: United Healthcare All Payer |
$6,899.77
|
|
|
SELF CENT HIP COMP 61MM 28MM
|
Facility
|
OP
|
$4,725.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.28 |
| Max. Negotiated Rate |
$4,536.24 |
| Rate for Payer: Aetna Commercial |
$3,638.44
|
| Rate for Payer: Anthem Medicaid |
$1,625.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,685.70
|
| Rate for Payer: Cash Price |
$2,362.62
|
| Rate for Payer: Cigna Commercial |
$3,921.96
|
| Rate for Payer: First Health Commercial |
$4,488.99
|
| Rate for Payer: Humana Commercial |
$4,016.46
|
| Rate for Payer: Humana KY Medicaid |
$1,625.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,641.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,874.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,487.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,158.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,543.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.83
|
| Rate for Payer: PHCS Commercial |
$4,536.24
|
| Rate for Payer: United Healthcare All Payer |
$4,158.22
|
|
|
SELF CENT HIP COMP 61MM 28MM
|
Facility
|
IP
|
$4,725.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.28 |
| Max. Negotiated Rate |
$4,536.24 |
| Rate for Payer: Aetna Commercial |
$3,638.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,685.70
|
| Rate for Payer: Cash Price |
$2,362.62
|
| Rate for Payer: Cigna Commercial |
$3,921.96
|
| Rate for Payer: First Health Commercial |
$4,488.99
|
| Rate for Payer: Humana Commercial |
$4,016.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,874.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,487.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,158.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,543.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.83
|
| Rate for Payer: PHCS Commercial |
$4,536.24
|
| Rate for Payer: United Healthcare All Payer |
$4,158.22
|
|
|
SELF CENT HIP COMP 63MM 28MM
|
Facility
|
IP
|
$7,415.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.07 |
| Max. Negotiated Rate |
$7,119.30 |
| Rate for Payer: Aetna Commercial |
$5,710.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,784.43
|
| Rate for Payer: Cash Price |
$3,707.97
|
| Rate for Payer: Cigna Commercial |
$6,155.23
|
| Rate for Payer: First Health Commercial |
$7,045.14
|
| Rate for Payer: Humana Commercial |
$6,303.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,081.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,526.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.94
|
| Rate for Payer: PHCS Commercial |
$7,119.30
|
| Rate for Payer: United Healthcare All Payer |
$6,526.03
|
|
|
SELF CENT HIP COMP 63MM 28MM
|
Facility
|
OP
|
$7,415.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.07 |
| Max. Negotiated Rate |
$7,119.30 |
| Rate for Payer: Aetna Commercial |
$5,710.27
|
| Rate for Payer: Anthem Medicaid |
$2,550.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,784.43
|
| Rate for Payer: Cash Price |
$3,707.97
|
| Rate for Payer: Cigna Commercial |
$6,155.23
|
| Rate for Payer: First Health Commercial |
$7,045.14
|
| Rate for Payer: Humana Commercial |
$6,303.55
|
| Rate for Payer: Humana KY Medicaid |
$2,550.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,576.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,081.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,601.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,526.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.94
|
| Rate for Payer: PHCS Commercial |
$7,119.30
|
| Rate for Payer: United Healthcare All Payer |
$6,526.03
|
|
|
SELF CENT HIP COMP 65MM 28MM
|
Facility
|
IP
|
$7,599.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.97 |
| Max. Negotiated Rate |
$7,295.76 |
| Rate for Payer: Aetna Commercial |
$5,851.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,927.80
|
| Rate for Payer: Cash Price |
$3,799.88
|
| Rate for Payer: Cigna Commercial |
$6,307.79
|
| Rate for Payer: First Health Commercial |
$7,219.76
|
| Rate for Payer: Humana Commercial |
$6,459.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,231.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,687.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,699.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.92
|
| Rate for Payer: PHCS Commercial |
$7,295.76
|
| Rate for Payer: United Healthcare All Payer |
$6,687.78
|
|
|
SELF CENT HIP COMP 65MM 28MM
|
Facility
|
OP
|
$7,599.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.97 |
| Max. Negotiated Rate |
$7,295.76 |
| Rate for Payer: Aetna Commercial |
$5,851.81
|
| Rate for Payer: Anthem Medicaid |
$2,613.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,927.80
|
| Rate for Payer: Cash Price |
$3,799.88
|
| Rate for Payer: Cigna Commercial |
$6,307.79
|
| Rate for Payer: First Health Commercial |
$7,219.76
|
| Rate for Payer: Humana Commercial |
$6,459.79
|
| Rate for Payer: Humana KY Medicaid |
$2,613.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,640.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,231.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,608.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,687.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,699.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,355.92
|
| Rate for Payer: PHCS Commercial |
$7,295.76
|
| Rate for Payer: United Healthcare All Payer |
$6,687.78
|
|
|
SELF PAY CT SCREEN COR ART
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
SELF PAY CT SCREEN COR ART
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
SELF PAY CT SCREEN COR ART
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$896.72 |
| Rate for Payer: Aetna Commercial |
$582.81
|
| Rate for Payer: Anthem Medicaid |
$417.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$896.72
|
| Rate for Payer: Healthspan PPO |
$373.16
|
| Rate for Payer: Humana Medicaid |
$417.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$426.25
|
| Rate for Payer: Molina Healthcare Passport |
$417.89
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.07
|
|
