|
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 |
$1,305.00 |
| 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 |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,784.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,001.50
|
| 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 |
$2,610.00 |
| Rate for Payer: Aetna Commercial |
$2,338.41
|
| Rate for Payer: Ambetter Exchange |
$1,444.27
|
| Rate for Payer: Anthem Medicaid |
$1,316.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,444.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,444.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,733.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,444.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,444.27
|
| 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 |
$1,877.55
|
| Rate for Payer: UHCCP Medicaid |
$1,522.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,329.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,444.27
|
|
|
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 |
$2,880.00 |
| 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 |
$7,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,352.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,624.00
|
| Rate for Payer: PHCS Commercial |
$9,216.00
|
| Rate for Payer: United Healthcare All Payer |
$8,448.00
|
|
|
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 |
$2,880.00 |
| 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 |
$7,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,352.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,624.00
|
| 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 |
761P0783
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,707.39 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$2,953.38
|
| Rate for Payer: Ambetter Exchange |
$1,804.73
|
| Rate for Payer: Anthem Medicaid |
$1,707.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,804.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,804.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,165.68
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,804.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,804.73
|
| 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 |
$2,346.15
|
| Rate for Payer: UHCCP Medicaid |
$3,360.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,724.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,804.73
|
|
|
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 |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$2,953.38
|
| Rate for Payer: Ambetter Exchange |
$1,804.73
|
| Rate for Payer: Anthem Medicaid |
$1,707.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,804.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,804.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,165.68
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,804.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,804.73
|
| 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 |
$2,346.15
|
| Rate for Payer: UHCCP Medicaid |
$3,360.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,724.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,804.73
|
|
|
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 |
$2,732.95 |
| Rate for Payer: Aetna Commercial |
$2,535.83
|
| Rate for Payer: Ambetter Exchange |
$1,584.23
|
| Rate for Payer: Anthem Medicaid |
$1,488.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,584.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,584.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,901.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,584.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.23
|
| 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 |
$2,059.50
|
| Rate for Payer: UHCCP Medicaid |
$1,580.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,503.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,584.23
|
|
|
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 |
$2,732.95 |
| Rate for Payer: Aetna Commercial |
$2,535.83
|
| Rate for Payer: Ambetter Exchange |
$1,584.23
|
| Rate for Payer: Anthem Medicaid |
$1,488.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,584.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,584.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,901.08
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,584.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.23
|
| 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 |
$2,059.50
|
| Rate for Payer: UHCCP Medicaid |
$1,580.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,503.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,584.23
|
|
|
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 |
$1,354.50 |
| 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 |
$3,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,928.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,115.35
|
| 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 |
$1,354.50 |
| 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 |
$3,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,928.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,115.35
|
| Rate for Payer: PHCS Commercial |
$4,334.40
|
| Rate for Payer: United Healthcare All Payer |
$3,973.20
|
|
|
TOT HIP BALL 32MM +11
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
TOT HIP BALL 32MM +11
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
TOT HIP BALL 32MM +15
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
TOT HIP BALL 32MM +15
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
TOT HIP BALL 32MM +5
|
Facility
|
IP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
TOT HIP BALL 32MM +5
|
Facility
|
OP
|
$5,160.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.04 |
| Max. Negotiated Rate |
$4,953.72 |
| Rate for Payer: Aetna Commercial |
$3,973.29
|
| Rate for Payer: Anthem Medicaid |
$1,774.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,024.89
|
| Rate for Payer: Cash Price |
$2,580.06
|
| Rate for Payer: Cigna Commercial |
$4,282.90
|
| Rate for Payer: First Health Commercial |
$4,902.11
|
| Rate for Payer: Humana Commercial |
$4,386.10
|
| Rate for Payer: Humana KY Medicaid |
$1,774.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,540.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,128.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,489.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,560.48
|
| Rate for Payer: PHCS Commercial |
$4,953.72
|
| Rate for Payer: United Healthcare All Payer |
$4,540.91
|
|
|
TOUCH PUMP 517750
|
Facility
|
IP
|
$28,246.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,473.88 |
| Max. Negotiated Rate |
$27,116.40 |
| Rate for Payer: Aetna Commercial |
$21,749.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,032.08
|
| Rate for Payer: Cash Price |
$14,123.12
|
| Rate for Payer: Cigna Commercial |
$23,444.39
|
| Rate for Payer: First Health Commercial |
$26,833.94
|
| Rate for Payer: Humana Commercial |
$24,009.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,161.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,845.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,473.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,856.70
|
| Rate for Payer: Ohio Health Group HMO |
$21,184.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,574.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,489.91
|
| Rate for Payer: PHCS Commercial |
$27,116.40
|
| Rate for Payer: United Healthcare All Payer |
$24,856.70
|
|
|
TOUCH PUMP 517750
|
Facility
|
OP
|
$28,246.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,473.88 |
| Max. Negotiated Rate |
$27,116.40 |
| Rate for Payer: Aetna Commercial |
$21,749.61
|
| Rate for Payer: Anthem Medicaid |
$9,713.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,032.08
|
| Rate for Payer: Cash Price |
$14,123.12
|
| Rate for Payer: Cigna Commercial |
$23,444.39
|
| Rate for Payer: First Health Commercial |
$26,833.94
|
| Rate for Payer: Humana Commercial |
$24,009.31
|
| Rate for Payer: Humana KY Medicaid |
$9,713.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9,812.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,161.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,845.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,473.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,908.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,856.70
|
| Rate for Payer: Ohio Health Group HMO |
$21,184.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,574.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,489.91
|
| Rate for Payer: PHCS Commercial |
$27,116.40
|
| Rate for Payer: United Healthcare All Payer |
$24,856.70
|
|
|
TOXOPLASMOSIS AB IGG
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
30001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
TOXOPLASMOSIS AB IGG
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
30001214
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$141.12 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$118.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$122.01
|
| Rate for Payer: First Health Commercial |
$139.65
|
| Rate for Payer: Humana Commercial |
$124.95
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.36
|
| Rate for Payer: Ohio Health Group HMO |
$110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.43
|
| Rate for Payer: PHCS Commercial |
$141.12
|
| Rate for Payer: United Healthcare All Payer |
$129.36
|
|
|
T-PLATE 6H
|
Facility
|
OP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem Medicaid |
$1,732.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Humana KY Medicaid |
$1,732.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
T-PLATE 6H
|
Facility
|
IP
|
$5,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.25 |
| Max. Negotiated Rate |
$4,836.00 |
| Rate for Payer: Aetna Commercial |
$3,878.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.25
|
| Rate for Payer: Cash Price |
$2,518.75
|
| Rate for Payer: Cigna Commercial |
$4,181.12
|
| Rate for Payer: First Health Commercial |
$4,785.62
|
| Rate for Payer: Humana Commercial |
$4,281.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,130.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,717.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,030.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,382.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,475.88
|
| Rate for Payer: PHCS Commercial |
$4,836.00
|
| Rate for Payer: United Healthcare All Payer |
$4,433.00
|
|
|
T-PLATE 7H
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
T-PLATE 7H
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
T-PLATE 8H
|
Facility
|
IP
|
$5,712.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,713.75 |
| Max. Negotiated Rate |
$5,484.00 |
| Rate for Payer: Aetna Commercial |
$4,398.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,455.75
|
| Rate for Payer: Cash Price |
$2,856.25
|
| Rate for Payer: Cigna Commercial |
$4,741.38
|
| Rate for Payer: First Health Commercial |
$5,426.88
|
| Rate for Payer: Humana Commercial |
$4,855.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,684.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,215.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,713.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,027.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,284.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,570.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,969.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,941.62
|
| Rate for Payer: PHCS Commercial |
$5,484.00
|
| Rate for Payer: United Healthcare All Payer |
$5,027.00
|
|
