|
REMEDY SPECTRUM GV FEM STEM MD
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
REMEDY SPECTRUM GV FEM STEM MD
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
REMEDY SPECTRUM GV FEM STEM SM
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
REMEDY SPECTRUM GV FEM STEM SM
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
REMEDY STEM EXTENSION 175
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
REMEDY STEM EXTENSION 175
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
REMEDY TIBIAL COMPONENT LRG
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
REMEDY TIBIAL COMPONENT LRG
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
REMEDY TIBIAL COMPONENT MED
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
REMEDY TIBIAL COMPONENT MED
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
REMEDY TIBIAL COMPONENT SMALL
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
REMEDY TIBIAL COMPONENT SMALL
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
REMEDY TIBIAL INSERT WEDGE LG
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
REMEDY TIBIAL INSERT WEDGE LG
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
REMEDY TIBIAL INSERT WEDGE MD
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
REMEDY TIBIAL INSERT WEDGE MD
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
REMEDY TIBIAL INSERT WEDGE SM
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
REMEDY TIBIAL INSERT WEDGE SM
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
REM ENDOVAS VENA CAVA FILTE(P
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
761P1532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.08 |
| Max. Negotiated Rate |
$3,690.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$299.08
|
| Rate for Payer: Anthem Medicaid |
$300.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,690.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$691.85
|
| Rate for Payer: Healthspan PPO |
$1,498.46
|
| Rate for Payer: Humana Medicaid |
$300.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$306.99
|
| Rate for Payer: Molina Healthcare Passport |
$300.97
|
| Rate for Payer: Multiplan PHCS |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,583.00
|
| Rate for Payer: UHCCP Medicaid |
$314.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$303.98
|
|
|
REM ENDOVAS VENA CAVA FILTER
|
Facility
|
IP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
76101532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.90
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
REM ENDOVAS VENA CAVA FILTER
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
76101532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.08 |
| Max. Negotiated Rate |
$3,690.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$299.08
|
| Rate for Payer: Anthem Medicaid |
$300.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,690.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$691.85
|
| Rate for Payer: Healthspan PPO |
$1,498.46
|
| Rate for Payer: Humana Medicaid |
$300.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$468.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$306.99
|
| Rate for Payer: Molina Healthcare Passport |
$300.97
|
| Rate for Payer: Multiplan PHCS |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,583.00
|
| Rate for Payer: UHCCP Medicaid |
$314.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$303.98
|
|
|
REM ENDOVAS VENA CAVA FILTER
|
Facility
|
OP
|
$3,690.00
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
76101532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem Medicaid |
$1,268.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Humana KY Medicaid |
$1,268.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$738.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.90
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
REMERON(MIRAZAPINE)45MG TAB
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 68084012101
|
| Hospital Charge Code |
25001301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
REMERON(MIRAZAPINE)45MG TAB
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 68084012101
|
| Hospital Charge Code |
25001301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
REMERON (MIRTAZAPINE) 15MG TAB
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
25001300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.22
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.91
|
| Rate for Payer: Ohio Health Group HMO |
$3.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Payer |
$3.91
|
|
