|
BIOFREEZE (3mL)
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 59316011511
|
| Hospital Charge Code |
25004097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.41 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.58
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.81
|
| Rate for Payer: First Health Commercial |
$4.36
|
| Rate for Payer: Humana Commercial |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.76
|
| 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 |
$4.04
|
| Rate for Payer: Ohio Health Group HMO |
$3.44
|
| 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 |
$1.42
|
| Rate for Payer: PHCS Commercial |
$4.41
|
| Rate for Payer: United Healthcare All Payer |
$4.04
|
|
|
BIOIMPEDANCE
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 93701
|
| Hospital Charge Code |
48000100
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
BIOIMPEDANCE
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 93701
|
| Hospital Charge Code |
48000100
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
BIOLOX CERAMIC HEAD 36*16/18
|
Facility
|
IP
|
$14,118.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.34 |
| Max. Negotiated Rate |
$13,553.30 |
| Rate for Payer: Aetna Commercial |
$10,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,012.06
|
| Rate for Payer: Cash Price |
$7,059.01
|
| Rate for Payer: Cigna Commercial |
$11,717.96
|
| Rate for Payer: First Health Commercial |
$13,412.12
|
| Rate for Payer: Humana Commercial |
$12,000.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,576.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,419.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,235.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,423.86
|
| Rate for Payer: Ohio Health Group HMO |
$10,588.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,823.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,835.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,376.59
|
| Rate for Payer: PHCS Commercial |
$13,553.30
|
| Rate for Payer: United Healthcare All Payer |
$12,423.86
|
|
|
BIOLOX CERAMIC HEAD 36*16/18
|
Facility
|
OP
|
$14,118.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.34 |
| Max. Negotiated Rate |
$13,553.30 |
| Rate for Payer: Aetna Commercial |
$10,870.88
|
| Rate for Payer: Anthem Medicaid |
$4,855.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,012.06
|
| Rate for Payer: Cash Price |
$7,059.01
|
| Rate for Payer: Cigna Commercial |
$11,717.96
|
| Rate for Payer: First Health Commercial |
$13,412.12
|
| Rate for Payer: Humana Commercial |
$12,000.32
|
| Rate for Payer: Humana KY Medicaid |
$4,855.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,904.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,576.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,419.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,235.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,952.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,423.86
|
| Rate for Payer: Ohio Health Group HMO |
$10,588.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,823.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,835.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,376.59
|
| Rate for Payer: PHCS Commercial |
$13,553.30
|
| Rate for Payer: United Healthcare All Payer |
$12,423.86
|
|
|
BIOLOX CER FEM HEAD 36MM +0
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
BIOLOX CER FEM HEAD 36MM +0
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
BIOLOX DELTA FEM HEAD PHA04402
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04402
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04404
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04404
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04406
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04406
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04408
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04408
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04410
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04410
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04412
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04412
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04414
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04414
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04416
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04416
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04418
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04418
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
