|
TOTAL THYROID LOBECTOMY
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
76102273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TOTAL THYROID LOBECTOMY
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
76102273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.51 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,122.99
|
| Rate for Payer: Anthem Medicaid |
$557.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,055.85
|
| Rate for Payer: Healthspan PPO |
$947.04
|
| Rate for Payer: Humana Medicaid |
$557.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$988.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.66
|
| Rate for Payer: Molina Healthcare Passport |
$557.51
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.09
|
|
|
TOTAL THYROID LOBECTOMY(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
761P2273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.51 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,122.99
|
| Rate for Payer: Anthem Medicaid |
$557.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,055.85
|
| Rate for Payer: Healthspan PPO |
$947.04
|
| Rate for Payer: Humana Medicaid |
$557.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$988.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.66
|
| Rate for Payer: Molina Healthcare Passport |
$557.51
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.09
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY
|
Facility
|
OP
|
$6,985.45
|
|
|
Service Code
|
CPT 60225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,989.61 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$6,985.45
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,989.61 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
76100784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem Medicaid |
$1,444.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Humana KY Medicaid |
$1,444.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,473.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
761P0784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.01 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$2,245.58
|
| Rate for Payer: Anthem Medicaid |
$1,306.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,425.81
|
| Rate for Payer: Healthspan PPO |
$2,034.00
|
| Rate for Payer: Humana Medicaid |
$1,306.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,863.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,332.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,306.01
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,940.00
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,319.07
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
76100784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.01 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$2,245.58
|
| Rate for Payer: Anthem Medicaid |
$1,306.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,425.81
|
| Rate for Payer: Healthspan PPO |
$2,034.00
|
| Rate for Payer: Humana Medicaid |
$1,306.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,863.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,332.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,306.01
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,940.00
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,319.07
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
76100784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
TOT HIPARTH FEM WWO ALGRFT
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
76100785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,316.66 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$2,338.41
|
| Rate for Payer: Anthem Medicaid |
$1,316.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,350.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cigna Commercial |
$2,524.82
|
| Rate for Payer: Healthspan PPO |
$2,118.10
|
| Rate for Payer: Humana Medicaid |
$1,316.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,939.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,342.99
|
| Rate for Payer: Molina Healthcare Passport |
$1,316.66
|
| Rate for Payer: Multiplan PHCS |
$2,610.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,045.00
|
| Rate for Payer: UHCCP Medicaid |
$1,522.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,329.83
|
|
|
TOT HIPARTH FEM WWO ALGRFT
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
76100785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Aetna Commercial |
$3,349.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cigna Commercial |
$3,610.50
|
| Rate for Payer: First Health Commercial |
$4,132.50
|
| Rate for Payer: Humana Commercial |
$3,697.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,210.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.50
|
| Rate for Payer: PHCS Commercial |
$4,176.00
|
| Rate for Payer: United Healthcare All Payer |
$3,828.00
|
|
|
TOT HIPARTH FEM WWO ALGRFT
|
Facility
|
OP
|
$4,350.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
76100785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.50 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Aetna Commercial |
$3,349.50
|
| Rate for Payer: Anthem Medicaid |
$1,495.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cigna Commercial |
$3,610.50
|
| Rate for Payer: First Health Commercial |
$4,132.50
|
| Rate for Payer: Humana Commercial |
$3,697.50
|
| Rate for Payer: Humana KY Medicaid |
$1,495.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,210.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,525.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.50
|
| Rate for Payer: PHCS Commercial |
$4,176.00
|
| Rate for Payer: United Healthcare All Payer |
$3,828.00
|
|
|
TOT HIPARTH FEM WWO ALGRFT(P
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
761P0785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,316.66 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$2,338.41
|
| Rate for Payer: Anthem Medicaid |
$1,316.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,350.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cigna Commercial |
$2,524.82
|
| Rate for Payer: Healthspan PPO |
$2,118.10
|
| Rate for Payer: Humana Medicaid |
$1,316.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,939.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,342.99
|
| Rate for Payer: Molina Healthcare Passport |
$1,316.66
|
| Rate for Payer: Multiplan PHCS |
$2,610.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,045.00
|
| Rate for Payer: UHCCP Medicaid |
$1,522.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,329.83
|
|
|
TOT HIP ARTHRP WWO AGRFTALGRFT
|
Facility
|
OP
|
$9,600.00
|
|
|
Service Code
|
HCPCS 27134
|
| Hospital Charge Code |
76100783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,248.00 |
| Max. Negotiated Rate |
$9,216.00 |
| Rate for Payer: Aetna Commercial |
$7,392.00
|
| Rate for Payer: Anthem Medicaid |
$3,301.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,488.00
|
| Rate for Payer: Cash Price |
$4,800.00
|
| Rate for Payer: Cigna Commercial |
$7,968.00
|
| Rate for Payer: First Health Commercial |
$9,120.00
|
| Rate for Payer: Humana Commercial |
$8,160.00
|
| Rate for Payer: Humana KY Medicaid |
$3,301.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,335.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,872.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,084.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,880.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,367.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,976.00
|
| Rate for Payer: PHCS Commercial |
$9,216.00
|
| Rate for Payer: United Healthcare All Payer |
$8,448.00
|
|
|
TOT HIP ARTHRP WWO AGRFTALGRFT
|
Professional
|
Both
|
$9,600.00
|
|
|
Service Code
|
HCPCS 27134
|
| Hospital Charge Code |
76100783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,707.39 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Aetna Commercial |
$2,953.38
|
| Rate for Payer: Anthem Medicaid |
$1,707.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,600.00
|
| Rate for Payer: Cash Price |
$4,800.00
|
| Rate for Payer: Cash Price |
$4,800.00
|
| Rate for Payer: Cigna Commercial |
$3,190.48
|
| Rate for Payer: Healthspan PPO |
$2,675.13
|
| Rate for Payer: Humana Medicaid |
$1,707.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,437.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,741.54
|
| Rate for Payer: Molina Healthcare Passport |
$1,707.39
|
| Rate for Payer: Multiplan PHCS |
$5,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,720.00
|
| Rate for Payer: UHCCP Medicaid |
$3,360.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,724.46
|
|
|
TOT HIP ARTHRP WWO AGRFTALGRFT
|
Professional
|
Both
|
$9,600.00
|
|
|
Service Code
|
HCPCS 27134
|
| Hospital Charge Code |
761P0783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,707.39 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Aetna Commercial |
$2,953.38
|
| Rate for Payer: Anthem Medicaid |
$1,707.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,600.00
|
| Rate for Payer: Cash Price |
$4,800.00
|
| Rate for Payer: Cash Price |
$4,800.00
|
| Rate for Payer: Cigna Commercial |
$3,190.48
|
| Rate for Payer: Healthspan PPO |
$2,675.13
|
| Rate for Payer: Humana Medicaid |
$1,707.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,437.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,741.54
|
| Rate for Payer: Molina Healthcare Passport |
$1,707.39
|
| Rate for Payer: Multiplan PHCS |
$5,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,720.00
|
| Rate for Payer: UHCCP Medicaid |
$3,360.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,724.46
|
|
|
TOT HIP ARTHRP WWO AGRFTALGRFT
|
Facility
|
IP
|
$9,600.00
|
|
|
Service Code
|
HCPCS 27134
|
| Hospital Charge Code |
76100783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,248.00 |
| Max. Negotiated Rate |
$9,216.00 |
| Rate for Payer: Aetna Commercial |
$7,392.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,488.00
|
| Rate for Payer: Cash Price |
$4,800.00
|
| Rate for Payer: Cigna Commercial |
$7,968.00
|
| Rate for Payer: First Health Commercial |
$9,120.00
|
| Rate for Payer: Humana Commercial |
$8,160.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,872.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,084.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,880.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,448.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,976.00
|
| Rate for Payer: PHCS Commercial |
$9,216.00
|
| Rate for Payer: United Healthcare All Payer |
$8,448.00
|
|
|
TOT HIP ARTH WWO AGRFT/ALGRF(P
|
Professional
|
Both
|
$4,515.00
|
|
|
Service Code
|
HCPCS 27132
|
| Hospital Charge Code |
761P0782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,488.80 |
| Max. Negotiated Rate |
$4,515.00 |
| Rate for Payer: Aetna Commercial |
$2,535.83
|
| Rate for Payer: Anthem Medicaid |
$1,488.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,515.00
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$2,732.95
|
| Rate for Payer: Healthspan PPO |
$2,296.92
|
| Rate for Payer: Humana Medicaid |
$1,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,116.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,518.58
|
| Rate for Payer: Molina Healthcare Passport |
$1,488.80
|
| Rate for Payer: Multiplan PHCS |
$2,709.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,160.50
|
| Rate for Payer: UHCCP Medicaid |
$1,580.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,503.69
|
|
|
TOT HIP ARTH WWO AGRFT/ALGRFT
|
Facility
|
IP
|
$4,515.00
|
|
|
Service Code
|
HCPCS 27132
|
| Hospital Charge Code |
76100782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$586.95 |
| Max. Negotiated Rate |
$4,334.40 |
| Rate for Payer: Aetna Commercial |
$3,476.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,521.70
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$3,747.45
|
| Rate for Payer: First Health Commercial |
$4,289.25
|
| Rate for Payer: Humana Commercial |
$3,837.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,702.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,332.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,973.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$903.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.65
|
| Rate for Payer: PHCS Commercial |
$4,334.40
|
| Rate for Payer: United Healthcare All Payer |
$3,973.20
|
|
|
TOT HIP ARTH WWO AGRFT/ALGRFT
|
Facility
|
OP
|
$4,515.00
|
|
|
Service Code
|
HCPCS 27132
|
| Hospital Charge Code |
76100782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$586.95 |
| Max. Negotiated Rate |
$4,334.40 |
| Rate for Payer: Aetna Commercial |
$3,476.55
|
| Rate for Payer: Anthem Medicaid |
$1,552.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,521.70
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$3,747.45
|
| Rate for Payer: First Health Commercial |
$4,289.25
|
| Rate for Payer: Humana Commercial |
$3,837.75
|
| Rate for Payer: Humana KY Medicaid |
$1,552.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,568.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,702.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,332.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,973.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$903.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.65
|
| Rate for Payer: PHCS Commercial |
$4,334.40
|
| Rate for Payer: United Healthcare All Payer |
$3,973.20
|
|
|
TOT HIP ARTH WWO AGRFT/ALGRFT
|
Professional
|
Both
|
$4,515.00
|
|
|
Service Code
|
HCPCS 27132
|
| Hospital Charge Code |
76100782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,488.80 |
| Max. Negotiated Rate |
$4,515.00 |
| Rate for Payer: Aetna Commercial |
$2,535.83
|
| Rate for Payer: Anthem Medicaid |
$1,488.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,515.00
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cash Price |
$2,257.50
|
| Rate for Payer: Cigna Commercial |
$2,732.95
|
| Rate for Payer: Healthspan PPO |
$2,296.92
|
| Rate for Payer: Humana Medicaid |
$1,488.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,116.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,518.58
|
| Rate for Payer: Molina Healthcare Passport |
$1,488.80
|
| Rate for Payer: Multiplan PHCS |
$2,709.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,160.50
|
| Rate for Payer: UHCCP Medicaid |
$1,580.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,503.69
|
|
|
TOT HIP BALL 32MM +11
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
TOT HIP BALL 32MM +11
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
TOT HIP BALL 32MM +15
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
TOT HIP BALL 32MM +15
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
