|
FEMORAL CPS SEG OSS TPR 10CM L
|
Facility
|
OP
|
$74,795.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,723.38 |
| Max. Negotiated Rate |
$71,803.39 |
| Rate for Payer: Aetna Commercial |
$57,592.30
|
| Rate for Payer: Anthem Medicaid |
$25,722.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,340.26
|
| Rate for Payer: Cash Price |
$37,397.60
|
| Rate for Payer: Cigna Commercial |
$62,080.02
|
| Rate for Payer: First Health Commercial |
$71,055.44
|
| Rate for Payer: Humana Commercial |
$63,575.92
|
| Rate for Payer: Humana KY Medicaid |
$25,722.07
|
| Rate for Payer: Kentucky WC Medicaid |
$25,983.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,332.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,198.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,438.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,238.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,819.78
|
| Rate for Payer: Ohio Health Group HMO |
$56,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,959.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,723.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,186.51
|
| Rate for Payer: PHCS Commercial |
$71,803.39
|
| Rate for Payer: United Healthcare All Payer |
$65,819.78
|
|
|
FEMORAL CPS SEG OSS TPR 10CM R
|
Facility
|
IP
|
$74,795.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,723.38 |
| Max. Negotiated Rate |
$71,803.39 |
| Rate for Payer: Aetna Commercial |
$57,592.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,340.26
|
| Rate for Payer: Cash Price |
$37,397.60
|
| Rate for Payer: Cigna Commercial |
$62,080.02
|
| Rate for Payer: First Health Commercial |
$71,055.44
|
| Rate for Payer: Humana Commercial |
$63,575.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,332.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,198.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,438.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,819.78
|
| Rate for Payer: Ohio Health Group HMO |
$56,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,959.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,723.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,186.51
|
| Rate for Payer: PHCS Commercial |
$71,803.39
|
| Rate for Payer: United Healthcare All Payer |
$65,819.78
|
|
|
FEMORAL CPS SEG OSS TPR 10CM R
|
Facility
|
OP
|
$74,795.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,723.38 |
| Max. Negotiated Rate |
$71,803.39 |
| Rate for Payer: Aetna Commercial |
$57,592.30
|
| Rate for Payer: Anthem Medicaid |
$25,722.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,340.26
|
| Rate for Payer: Cash Price |
$37,397.60
|
| Rate for Payer: Cigna Commercial |
$62,080.02
|
| Rate for Payer: First Health Commercial |
$71,055.44
|
| Rate for Payer: Humana Commercial |
$63,575.92
|
| Rate for Payer: Humana KY Medicaid |
$25,722.07
|
| Rate for Payer: Kentucky WC Medicaid |
$25,983.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,332.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,198.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,438.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,238.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,819.78
|
| Rate for Payer: Ohio Health Group HMO |
$56,096.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,959.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,723.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,186.51
|
| Rate for Payer: PHCS Commercial |
$71,803.39
|
| Rate for Payer: United Healthcare All Payer |
$65,819.78
|
|
|
FEMORAL CPS SEG OSS TPR 7CM L
|
Facility
|
IP
|
$70,518.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,167.39 |
| Max. Negotiated Rate |
$67,697.66 |
| Rate for Payer: Aetna Commercial |
$54,299.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,004.35
|
| Rate for Payer: Cash Price |
$35,259.20
|
| Rate for Payer: Cigna Commercial |
$58,530.27
|
| Rate for Payer: First Health Commercial |
$66,992.48
|
| Rate for Payer: Humana Commercial |
$59,940.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,825.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,042.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,155.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,056.19
|
| Rate for Payer: Ohio Health Group HMO |
$52,888.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,103.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,167.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,860.70
|
| Rate for Payer: PHCS Commercial |
$67,697.66
|
| Rate for Payer: United Healthcare All Payer |
$62,056.19
|
|
|
FEMORAL CPS SEG OSS TPR 7CM L
|
Facility
|
OP
|
$70,518.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,167.39 |
| Max. Negotiated Rate |
$67,697.66 |
| Rate for Payer: Aetna Commercial |
$54,299.17
|
| Rate for Payer: Anthem Medicaid |
$24,251.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,004.35
|
| Rate for Payer: Cash Price |
$35,259.20
|
| Rate for Payer: Cigna Commercial |
$58,530.27
|
| Rate for Payer: First Health Commercial |
$66,992.48
|
| Rate for Payer: Humana Commercial |
$59,940.64
|
| Rate for Payer: Humana KY Medicaid |
$24,251.28
|
| Rate for Payer: Kentucky WC Medicaid |
$24,498.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,825.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,042.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,155.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,737.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,056.19
|
| Rate for Payer: Ohio Health Group HMO |
$52,888.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,103.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,167.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,860.70
|
| Rate for Payer: PHCS Commercial |
$67,697.66
|
| Rate for Payer: United Healthcare All Payer |
$62,056.19
|
|
|
FEMORAL CPS SEG OSS TPR 7CM R
|
Facility
|
OP
|
$70,518.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,167.39 |
| Max. Negotiated Rate |
$67,697.66 |
| Rate for Payer: Aetna Commercial |
$54,299.17
|
| Rate for Payer: Anthem Medicaid |
$24,251.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,004.35
|
| Rate for Payer: Cash Price |
$35,259.20
|
| Rate for Payer: Cigna Commercial |
$58,530.27
|
| Rate for Payer: First Health Commercial |
$66,992.48
|
| Rate for Payer: Humana Commercial |
$59,940.64
|
| Rate for Payer: Humana KY Medicaid |
$24,251.28
|
| Rate for Payer: Kentucky WC Medicaid |
$24,498.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,825.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,042.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,155.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,737.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,056.19
|
| Rate for Payer: Ohio Health Group HMO |
$52,888.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,103.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,167.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,860.70
|
| Rate for Payer: PHCS Commercial |
$67,697.66
|
| Rate for Payer: United Healthcare All Payer |
$62,056.19
|
|
|
FEMORAL CPS SEG OSS TPR 7CM R
|
Facility
|
IP
|
$70,518.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,167.39 |
| Max. Negotiated Rate |
$67,697.66 |
| Rate for Payer: Aetna Commercial |
$54,299.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,004.35
|
| Rate for Payer: Cash Price |
$35,259.20
|
| Rate for Payer: Cigna Commercial |
$58,530.27
|
| Rate for Payer: First Health Commercial |
$66,992.48
|
| Rate for Payer: Humana Commercial |
$59,940.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,825.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,042.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,155.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,056.19
|
| Rate for Payer: Ohio Health Group HMO |
$52,888.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,103.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,167.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,860.70
|
| Rate for Payer: PHCS Commercial |
$67,697.66
|
| Rate for Payer: United Healthcare All Payer |
$62,056.19
|
|
|
FEMORAL FIBERTAG
|
Facility
|
IP
|
$4,129.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.82 |
| Max. Negotiated Rate |
$3,964.20 |
| Rate for Payer: Aetna Commercial |
$3,179.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,220.92
|
| Rate for Payer: Cash Price |
$2,064.69
|
| Rate for Payer: Cigna Commercial |
$3,427.39
|
| Rate for Payer: First Health Commercial |
$3,922.91
|
| Rate for Payer: Humana Commercial |
$3,509.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,633.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,280.11
|
| Rate for Payer: PHCS Commercial |
$3,964.20
|
| Rate for Payer: United Healthcare All Payer |
$3,633.85
|
|
|
FEMORAL FIBERTAG
|
Facility
|
OP
|
$4,129.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.82 |
| Max. Negotiated Rate |
$3,964.20 |
| Rate for Payer: Aetna Commercial |
$3,179.62
|
| Rate for Payer: Anthem Medicaid |
$1,420.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,220.92
|
| Rate for Payer: Cash Price |
$2,064.69
|
| Rate for Payer: Cigna Commercial |
$3,427.39
|
| Rate for Payer: First Health Commercial |
$3,922.91
|
| Rate for Payer: Humana Commercial |
$3,509.97
|
| Rate for Payer: Humana KY Medicaid |
$1,420.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,434.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,448.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,633.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,280.11
|
| Rate for Payer: PHCS Commercial |
$3,964.20
|
| Rate for Payer: United Healthcare All Payer |
$3,633.85
|
|
|
FEMORAL HEAD W/O CARTILAGE
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
FEMORAL HEAD W/O CARTILAGE
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,735.68 |
| Rate for Payer: Aetna Commercial |
$1,392.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.24
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cigna Commercial |
$1,500.64
|
| Rate for Payer: First Health Commercial |
$1,717.60
|
| Rate for Payer: Humana Commercial |
$1,536.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.48
|
| Rate for Payer: PHCS Commercial |
$1,735.68
|
| Rate for Payer: United Healthcare All Payer |
$1,591.04
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Professional
|
Both
|
$2,247.83
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
76101454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$2,247.83 |
| Rate for Payer: Healthspan PPO |
$258.20
|
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.81
|
| Rate for Payer: Anthem Medicaid |
$47.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,247.83
|
| Rate for Payer: Cash Price |
$1,123.91
|
| Rate for Payer: Cash Price |
$1,123.91
|
| Rate for Payer: Cigna Commercial |
$83.70
|
| Rate for Payer: Humana Medicaid |
$47.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$1,348.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,573.48
|
| Rate for Payer: UHCCP Medicaid |
$38.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
OP
|
$2,247.83
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
76101454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.22 |
| Max. Negotiated Rate |
$2,157.92 |
| Rate for Payer: Aetna Commercial |
$1,730.83
|
| Rate for Payer: Anthem Medicaid |
$773.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.31
|
| Rate for Payer: Cash Price |
$1,123.91
|
| Rate for Payer: Cigna Commercial |
$1,865.70
|
| Rate for Payer: First Health Commercial |
$2,135.44
|
| Rate for Payer: Humana Commercial |
$1,910.66
|
| Rate for Payer: Humana KY Medicaid |
$773.03
|
| Rate for Payer: Kentucky WC Medicaid |
$780.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,658.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,685.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.83
|
| Rate for Payer: PHCS Commercial |
$2,157.92
|
| Rate for Payer: United Healthcare All Payer |
$1,978.09
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
IP
|
$2,247.83
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
76101454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.22 |
| Max. Negotiated Rate |
$2,157.92 |
| Rate for Payer: Aetna Commercial |
$1,730.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.31
|
| Rate for Payer: Cash Price |
$1,123.91
|
| Rate for Payer: Cigna Commercial |
$1,865.70
|
| Rate for Payer: First Health Commercial |
$2,135.44
|
| Rate for Payer: Humana Commercial |
$1,910.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,658.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,685.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.83
|
| Rate for Payer: PHCS Commercial |
$2,157.92
|
| Rate for Payer: United Healthcare All Payer |
$1,978.09
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,735.68 |
| Rate for Payer: Aetna Commercial |
$1,392.16
|
| Rate for Payer: Anthem Medicaid |
$621.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,410.24
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cigna Commercial |
$1,500.64
|
| Rate for Payer: First Health Commercial |
$1,717.60
|
| Rate for Payer: Humana Commercial |
$1,536.80
|
| Rate for Payer: Humana KY Medicaid |
$621.77
|
| Rate for Payer: Kentucky WC Medicaid |
$628.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,482.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,334.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.48
|
| Rate for Payer: PHCS Commercial |
$1,735.68
|
| Rate for Payer: United Healthcare All Payer |
$1,591.04
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3R(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
761P1454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.81
|
| Rate for Payer: Anthem Medicaid |
$47.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$83.70
|
| Rate for Payer: Healthspan PPO |
$258.20
|
| Rate for Payer: Humana Medicaid |
$47.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$38.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3R(T
|
Facility
|
OP
|
$1,747.83
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
761T1454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.22 |
| Max. Negotiated Rate |
$1,677.92 |
| Rate for Payer: Aetna Commercial |
$1,345.83
|
| Rate for Payer: Anthem Medicaid |
$601.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,363.31
|
| Rate for Payer: Cash Price |
$873.92
|
| Rate for Payer: Cigna Commercial |
$1,450.70
|
| Rate for Payer: First Health Commercial |
$1,660.44
|
| Rate for Payer: Humana Commercial |
$1,485.66
|
| Rate for Payer: Humana KY Medicaid |
$601.08
|
| Rate for Payer: Kentucky WC Medicaid |
$607.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,433.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,538.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.83
|
| Rate for Payer: PHCS Commercial |
$1,677.92
|
| Rate for Payer: United Healthcare All Payer |
$1,538.09
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3R(T
|
Facility
|
IP
|
$1,747.83
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
761T1454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.22 |
| Max. Negotiated Rate |
$1,677.92 |
| Rate for Payer: Aetna Commercial |
$1,345.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,363.31
|
| Rate for Payer: Cash Price |
$873.92
|
| Rate for Payer: Cigna Commercial |
$1,450.70
|
| Rate for Payer: First Health Commercial |
$1,660.44
|
| Rate for Payer: Humana Commercial |
$1,485.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,433.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,538.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.83
|
| Rate for Payer: PHCS Commercial |
$1,677.92
|
| Rate for Payer: United Healthcare All Payer |
$1,538.09
|
|
|
FEMORAL JIG HEAD LEFT LD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG HEAD LEFT LD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG HEAD RIGHT LD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG HEAD RIGHT LD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG LT LD LOW PROFILE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG LT LD LOW PROFILE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
