|
SELF CENT HIP COMP 47MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 47MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 48MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 48MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 49MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 49MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 50MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 50MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 51MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 51MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 52MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 52MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 53MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 53MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 54MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 54MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 55MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 55MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 56MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 56MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 57MM 28MM
|
Facility
|
IP
|
$9,741.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,922.47 |
| Max. Negotiated Rate |
$9,351.89 |
| Rate for Payer: Aetna Commercial |
$7,500.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,598.41
|
| Rate for Payer: Cash Price |
$4,870.77
|
| Rate for Payer: Cigna Commercial |
$8,085.49
|
| Rate for Payer: First Health Commercial |
$9,254.47
|
| Rate for Payer: Humana Commercial |
$8,280.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,988.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,189.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,922.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,572.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,306.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,793.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,475.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,721.67
|
| Rate for Payer: PHCS Commercial |
$9,351.89
|
| Rate for Payer: United Healthcare All Payer |
$8,572.56
|
|
|
SELF CENT HIP COMP 57MM 28MM
|
Facility
|
OP
|
$9,741.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,922.47 |
| Max. Negotiated Rate |
$9,351.89 |
| Rate for Payer: Aetna Commercial |
$7,500.99
|
| Rate for Payer: Anthem Medicaid |
$3,350.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,598.41
|
| Rate for Payer: Cash Price |
$4,870.77
|
| Rate for Payer: Cigna Commercial |
$8,085.49
|
| Rate for Payer: First Health Commercial |
$9,254.47
|
| Rate for Payer: Humana Commercial |
$8,280.32
|
| Rate for Payer: Humana KY Medicaid |
$3,350.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,384.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,988.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,189.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,922.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,417.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,572.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,306.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,793.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,475.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,721.67
|
| Rate for Payer: PHCS Commercial |
$9,351.89
|
| Rate for Payer: United Healthcare All Payer |
$8,572.56
|
|
|
SELF CENT HIP COMP 59MM 28MM
|
Facility
|
IP
|
$8,040.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,412.20 |
| Max. Negotiated Rate |
$7,719.02 |
| Rate for Payer: Aetna Commercial |
$6,191.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,271.71
|
| Rate for Payer: Cash Price |
$4,020.32
|
| Rate for Payer: Cigna Commercial |
$6,673.74
|
| Rate for Payer: First Health Commercial |
$7,638.62
|
| Rate for Payer: Humana Commercial |
$6,834.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,593.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,934.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,412.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,075.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,030.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,432.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,995.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,548.05
|
| Rate for Payer: PHCS Commercial |
$7,719.02
|
| Rate for Payer: United Healthcare All Payer |
$7,075.77
|
|
|
SELF CENT HIP COMP 59MM 28MM
|
Facility
|
OP
|
$8,040.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,412.20 |
| Max. Negotiated Rate |
$7,719.02 |
| Rate for Payer: Aetna Commercial |
$6,191.30
|
| Rate for Payer: Anthem Medicaid |
$2,765.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,271.71
|
| Rate for Payer: Cash Price |
$4,020.32
|
| Rate for Payer: Cigna Commercial |
$6,673.74
|
| Rate for Payer: First Health Commercial |
$7,638.62
|
| Rate for Payer: Humana Commercial |
$6,834.55
|
| Rate for Payer: Humana KY Medicaid |
$2,765.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,793.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,593.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,934.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,412.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,820.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,075.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,030.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,432.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,995.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,548.05
|
| Rate for Payer: PHCS Commercial |
$7,719.02
|
| Rate for Payer: United Healthcare All Payer |
$7,075.77
|
|
|
SELF CENT HIP COMP 61MM 28MM
|
Facility
|
OP
|
$4,705.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.69 |
| Max. Negotiated Rate |
$4,517.40 |
| Rate for Payer: Aetna Commercial |
$3,623.33
|
| Rate for Payer: Anthem Medicaid |
$1,618.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,670.38
|
| Rate for Payer: Cash Price |
$2,352.81
|
| Rate for Payer: Cigna Commercial |
$3,905.66
|
| Rate for Payer: First Health Commercial |
$4,470.34
|
| Rate for Payer: Humana Commercial |
$3,999.78
|
| Rate for Payer: Humana KY Medicaid |
$1,618.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,858.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,472.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,140.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,529.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,093.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,246.88
|
| Rate for Payer: PHCS Commercial |
$4,517.40
|
| Rate for Payer: United Healthcare All Payer |
$4,140.95
|
|
