|
FEMORAL FIBERTAG
|
Facility
|
OP
|
$4,067.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.16 |
| Max. Negotiated Rate |
$3,904.50 |
| Rate for Payer: Aetna Commercial |
$3,131.74
|
| Rate for Payer: Anthem Medicaid |
$1,398.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,172.41
|
| Rate for Payer: Cash Price |
$2,033.59
|
| Rate for Payer: Cigna Commercial |
$3,375.77
|
| Rate for Payer: First Health Commercial |
$3,863.83
|
| Rate for Payer: Humana Commercial |
$3,457.11
|
| Rate for Payer: Humana KY Medicaid |
$1,398.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,335.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,001.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,579.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,050.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,806.36
|
| Rate for Payer: PHCS Commercial |
$3,904.50
|
| Rate for Payer: United Healthcare All Payer |
$3,579.13
|
|
|
FEMORAL FIBERTAG
|
Facility
|
IP
|
$4,067.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.16 |
| Max. Negotiated Rate |
$3,904.50 |
| Rate for Payer: Aetna Commercial |
$3,131.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,172.41
|
| Rate for Payer: Cash Price |
$2,033.59
|
| Rate for Payer: Cigna Commercial |
$3,375.77
|
| Rate for Payer: First Health Commercial |
$3,863.83
|
| Rate for Payer: Humana Commercial |
$3,457.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,335.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,001.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,579.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,050.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,806.36
|
| Rate for Payer: PHCS Commercial |
$3,904.50
|
| Rate for Payer: United Healthcare All Payer |
$3,579.13
|
|
|
FEMORAL HEAD TAPER 12/14 225 7
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
FEMORAL HEAD TAPER 12/14 225 7
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
FEMORAL HEAD W/O CARTILAGE
|
Facility
|
IP
|
$5,731.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
FEMORAL HEAD W/O CARTILAGE
|
Facility
|
OP
|
$5,731.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem Medicaid |
$1,970.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Humana KY Medicaid |
$1,970.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,991.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,010.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
FEMORAL HINGED 2 LEFT
|
Facility
|
OP
|
$35,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,500.00 |
| Max. Negotiated Rate |
$33,600.00 |
| Rate for Payer: Aetna Commercial |
$26,950.00
|
| Rate for Payer: Anthem Medicaid |
$12,036.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,300.00
|
| Rate for Payer: Cash Price |
$17,500.00
|
| Rate for Payer: Cigna Commercial |
$29,050.00
|
| Rate for Payer: First Health Commercial |
$33,250.00
|
| Rate for Payer: Humana Commercial |
$29,750.00
|
| Rate for Payer: Humana KY Medicaid |
$12,036.50
|
| Rate for Payer: Kentucky WC Medicaid |
$12,159.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,700.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,830.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,800.00
|
| Rate for Payer: Ohio Health Group HMO |
$26,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,450.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,150.00
|
| Rate for Payer: PHCS Commercial |
$33,600.00
|
| Rate for Payer: United Healthcare All Payer |
$30,800.00
|
|
|
FEMORAL HINGED 2 LEFT
|
Facility
|
IP
|
$35,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,500.00 |
| Max. Negotiated Rate |
$33,600.00 |
| Rate for Payer: Aetna Commercial |
$26,950.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,300.00
|
| Rate for Payer: Cash Price |
$17,500.00
|
| Rate for Payer: Cigna Commercial |
$29,050.00
|
| Rate for Payer: First Health Commercial |
$33,250.00
|
| Rate for Payer: Humana Commercial |
$29,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,700.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,830.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,800.00
|
| Rate for Payer: Ohio Health Group HMO |
$26,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,450.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,150.00
|
| Rate for Payer: PHCS Commercial |
$33,600.00
|
| Rate for Payer: United Healthcare All Payer |
$30,800.00
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
OP
|
$1,871.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$561.30 |
| Max. Negotiated Rate |
$1,796.16 |
| Rate for Payer: Aetna Commercial |
$1,440.67
|
| Rate for Payer: Anthem Medicaid |
$643.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.38
|
| Rate for Payer: Cash Price |
$935.50
|
| Rate for Payer: Cigna Commercial |
$1,552.93
|
| Rate for Payer: First Health Commercial |
$1,777.45
|
| Rate for Payer: Humana Commercial |
$1,590.35
|
| Rate for Payer: Humana KY Medicaid |
$643.44
|
| Rate for Payer: Kentucky WC Medicaid |
$649.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.99
|
| Rate for Payer: PHCS Commercial |
$1,796.16
|
| Rate for Payer: United Healthcare All Payer |
$1,646.48
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
IP
|
$2,309.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
76101454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.70 |
| Max. Negotiated Rate |
$2,216.64 |
| Rate for Payer: Aetna Commercial |
$1,777.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,801.02
|
| Rate for Payer: Cash Price |
$1,154.50
|
| Rate for Payer: Cigna Commercial |
$1,916.47
|
| Rate for Payer: First Health Commercial |
$2,193.55
|
| Rate for Payer: Humana Commercial |
$1,962.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,893.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,704.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,031.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,731.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,847.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,008.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.21
|
| Rate for Payer: PHCS Commercial |
$2,216.64
|
| Rate for Payer: United Healthcare All Payer |
$2,031.92
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Professional
|
Both
|
$2,309.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
76101454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$1,385.40 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Ambetter Exchange |
$45.26
|
| 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 Individual/Medicaid |
$45.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.31
|
| Rate for Payer: Cash Price |
$1,154.50
|
| Rate for Payer: Cash Price |
$1,154.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.43
|
| Rate for Payer: Molina Healthcare Passport |
$47.48
|
| Rate for Payer: Multiplan PHCS |
$1,385.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.84
|
| Rate for Payer: UHCCP Medicaid |
$38.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.26
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
IP
|
$1,871.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
48100024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$561.30 |
| Max. Negotiated Rate |
$1,796.16 |
| Rate for Payer: Aetna Commercial |
$1,440.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,459.38
|
| Rate for Payer: Cash Price |
$935.50
|
| Rate for Payer: Cigna Commercial |
$1,552.93
|
| Rate for Payer: First Health Commercial |
$1,777.45
|
| Rate for Payer: Humana Commercial |
$1,590.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,646.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,627.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.99
|
| Rate for Payer: PHCS Commercial |
$1,796.16
|
| Rate for Payer: United Healthcare All Payer |
$1,646.48
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3RD
|
Facility
|
OP
|
$2,309.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
76101454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.70 |
| Max. Negotiated Rate |
$2,216.64 |
| Rate for Payer: Aetna Commercial |
$1,777.93
|
| Rate for Payer: Anthem Medicaid |
$794.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,801.02
|
| Rate for Payer: Cash Price |
$1,154.50
|
| Rate for Payer: Cigna Commercial |
$1,916.47
|
| Rate for Payer: First Health Commercial |
$2,193.55
|
| Rate for Payer: Humana Commercial |
$1,962.65
|
| Rate for Payer: Humana KY Medicaid |
$794.07
|
| Rate for Payer: Kentucky WC Medicaid |
$802.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,893.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,704.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,031.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,731.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,847.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,008.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.21
|
| Rate for Payer: PHCS Commercial |
$2,216.64
|
| Rate for Payer: United Healthcare All Payer |
$2,031.92
|
|
|
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 |
$300.00 |
| Rate for Payer: Aetna Commercial |
$90.91
|
| Rate for Payer: Ambetter Exchange |
$45.26
|
| 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 Individual/Medicaid |
$45.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.26
|
| 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 |
$58.84
|
| Rate for Payer: UHCCP Medicaid |
$38.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.26
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3R(T
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
761T1454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.70 |
| Max. Negotiated Rate |
$1,736.64 |
| Rate for Payer: Aetna Commercial |
$1,392.93
|
| Rate for Payer: Anthem Medicaid |
$622.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.02
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cigna Commercial |
$1,501.47
|
| Rate for Payer: First Health Commercial |
$1,718.55
|
| Rate for Payer: Humana Commercial |
$1,537.65
|
| Rate for Payer: Humana KY Medicaid |
$622.12
|
| Rate for Payer: Kentucky WC Medicaid |
$628.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,573.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.21
|
| Rate for Payer: PHCS Commercial |
$1,736.64
|
| Rate for Payer: United Healthcare All Payer |
$1,591.92
|
|
|
FEMORAL/ILIAC CONTRAL 2ND/3R(T
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
HCPCS 36248
|
| Hospital Charge Code |
761T1454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.70 |
| Max. Negotiated Rate |
$1,736.64 |
| Rate for Payer: Aetna Commercial |
$1,392.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.02
|
| Rate for Payer: Cash Price |
$904.50
|
| Rate for Payer: Cigna Commercial |
$1,501.47
|
| Rate for Payer: First Health Commercial |
$1,718.55
|
| Rate for Payer: Humana Commercial |
$1,537.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,591.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,573.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.21
|
| Rate for Payer: PHCS Commercial |
$1,736.64
|
| Rate for Payer: United Healthcare All Payer |
$1,591.92
|
|
|
FEMORAL JIG HEAD LEFT LD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL JIG RT LD LOW PROFILE
|
Facility
|
IP
|
$5,712.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
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
|
|
|
FEMORAL JIG RT LD LOW PROFILE
|
Facility
|
OP
|
$5,712.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
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 Medicaid |
$1,964.53
|
| 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: Humana KY Medicaid |
$1,964.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,984.52
|
| 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: Molina Healthcare Medicaid |
$2,003.94
|
| 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
|
|
|
FEMORAL JIG TAIL LEFT LD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
