|
ACETABULAR CUP 62MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 62MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 64MM
|
Facility
|
OP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem Medicaid |
$9,831.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Humana KY Medicaid |
$9,831.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,931.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,028.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 64MM
|
Facility
|
IP
|
$28,587.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,576.25 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$22,012.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,298.25
|
| Rate for Payer: Cash Price |
$14,293.75
|
| Rate for Payer: Cigna Commercial |
$23,727.62
|
| Rate for Payer: First Health Commercial |
$27,158.12
|
| Rate for Payer: Humana Commercial |
$24,299.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,441.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,097.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,576.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,440.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,870.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,871.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,725.38
|
| Rate for Payer: PHCS Commercial |
$27,444.00
|
| Rate for Payer: United Healthcare All Payer |
$25,157.00
|
|
|
ACETABULAR CUP 66MM
|
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
|
|
|
ACETABULAR CUP 66MM
|
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
|
|
|
ACETABULAR LINER 32ID54-56ODW
|
Facility
|
OP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem Medicaid |
$3,124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Humana KY Medicaid |
$3,124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
ACETABULAR LINER 32ID54-56ODW
|
Facility
|
IP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
ACETABULAR LINER 32ID58-60ODW
|
Facility
|
IP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
ACETABULAR LINER 32ID58-60ODW
|
Facility
|
OP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem Medicaid |
$3,124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Humana KY Medicaid |
$3,124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
ACETABULAR LINER 44MMX56MM
|
Facility
|
IP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
ACETABULAR LINER 44MMX56MM
|
Facility
|
OP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem Medicaid |
$7,090.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Humana KY Medicaid |
$7,090.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,162.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,233.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
ACETABULAR LINER 48MMX60MM
|
Facility
|
OP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem Medicaid |
$7,090.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Humana KY Medicaid |
$7,090.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,162.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,233.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
ACETABULAR LINER 48MMX60MM
|
Facility
|
IP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
ACETABULAR R3 LINER
|
Facility
|
OP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem Medicaid |
$7,090.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Humana KY Medicaid |
$7,090.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,162.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,233.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
ACETABULAR R3 LINER
|
Facility
|
IP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
ACETADOTE 100MG 6GM/30ML VIAL
|
Facility
|
IP
|
$322.25
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
25001823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.67 |
| Max. Negotiated Rate |
$309.36 |
| Rate for Payer: Aetna Commercial |
$248.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.35
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cigna Commercial |
$267.47
|
| Rate for Payer: First Health Commercial |
$306.14
|
| Rate for Payer: Humana Commercial |
$273.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.58
|
| Rate for Payer: Ohio Health Group HMO |
$241.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.35
|
| Rate for Payer: PHCS Commercial |
$309.36
|
| Rate for Payer: United Healthcare All Payer |
$283.58
|
|
|
ACETADOTE 100MG 6GM/30ML VIAL
|
Facility
|
OP
|
$322.25
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
25001823
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.67 |
| Max. Negotiated Rate |
$309.36 |
| Rate for Payer: Aetna Commercial |
$248.13
|
| Rate for Payer: Anthem Medicaid |
$110.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.35
|
| Rate for Payer: Cash Price |
$161.12
|
| Rate for Payer: Cigna Commercial |
$267.47
|
| Rate for Payer: First Health Commercial |
$306.14
|
| Rate for Payer: Humana Commercial |
$273.91
|
| Rate for Payer: Humana KY Medicaid |
$110.82
|
| Rate for Payer: Kentucky WC Medicaid |
$111.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.58
|
| Rate for Payer: Ohio Health Group HMO |
$241.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.35
|
| Rate for Payer: PHCS Commercial |
$309.36
|
| Rate for Payer: United Healthcare All Payer |
$283.58
|
|
|
ACETAMIN (BBRAUN) 10MG(500MG)
|
Facility
|
IP
|
$33.46
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
25004436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna Commercial |
$25.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.10
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: First Health Commercial |
$31.79
|
| Rate for Payer: Humana Commercial |
$28.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.44
|
| Rate for Payer: Ohio Health Group HMO |
$25.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.09
|
| Rate for Payer: PHCS Commercial |
$32.12
|
| Rate for Payer: United Healthcare All Payer |
$29.44
|
|
|
ACETAMIN (BBRAUN) 10MG(500MG)
|
Facility
|
OP
|
$33.46
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
25004436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna Commercial |
$25.76
|
| Rate for Payer: Anthem Medicaid |
$11.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.10
|
| Rate for Payer: Cash Price |
$16.73
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: First Health Commercial |
$31.79
|
| Rate for Payer: Humana Commercial |
$28.44
|
| Rate for Payer: Humana KY Medicaid |
$11.51
|
| Rate for Payer: Kentucky WC Medicaid |
$11.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.44
|
| Rate for Payer: Ohio Health Group HMO |
$25.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.09
|
| Rate for Payer: PHCS Commercial |
$32.12
|
| Rate for Payer: United Healthcare All Payer |
$29.44
|
|
|
ACETAMIN(GENERIC)10MG(1000MG)
|
Facility
|
OP
|
$51.78
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
25001822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Aetna Commercial |
$39.87
|
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem Medicaid |
$17.81
|
| Rate for Payer: Anthem Medicaid |
$22.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cigna Commercial |
$42.98
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: First Health Commercial |
$49.19
|
| Rate for Payer: Humana Commercial |
$44.01
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana KY Medicaid |
$17.81
|
| Rate for Payer: Humana KY Medicaid |
$22.49
|
| Rate for Payer: Kentucky WC Medicaid |
$22.72
|
| Rate for Payer: Kentucky WC Medicaid |
$17.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$38.84
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.13
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: PHCS Commercial |
$49.71
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
| Rate for Payer: United Healthcare All Payer |
$45.57
|
|
|
ACETAMIN(GENERIC)10MG(1000MG)
|
Facility
|
IP
|
$51.78
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
25001822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$49.71 |
| Rate for Payer: Aetna Commercial |
$39.87
|
| Rate for Payer: Aetna Commercial |
$50.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.01
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$42.98
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: First Health Commercial |
$62.13
|
| Rate for Payer: First Health Commercial |
$49.19
|
| Rate for Payer: Humana Commercial |
$55.59
|
| Rate for Payer: Humana Commercial |
$44.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.55
|
| Rate for Payer: Ohio Health Group HMO |
$38.84
|
| Rate for Payer: Ohio Health Group HMO |
$49.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.73
|
| Rate for Payer: PHCS Commercial |
$49.71
|
| Rate for Payer: PHCS Commercial |
$62.78
|
| Rate for Payer: United Healthcare All Payer |
$45.57
|
| Rate for Payer: United Healthcare All Payer |
$57.55
|
|
|
ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
30000070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.64
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$18.64
|
| Rate for Payer: Humana Medicare Advantage |
$18.64
|
| Rate for Payer: Kentucky WC Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 80143
|
| Hospital Charge Code |
30000070
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
ACETASOL(ACTICACIDHC)2%SOL10ML
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 51672300701
|
| Hospital Charge Code |
25000142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.16
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Cigna Commercial |
$2.30
|
| Rate for Payer: First Health Commercial |
$2.63
|
| Rate for Payer: Humana Commercial |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.91
|
| Rate for Payer: PHCS Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Payer |
$2.44
|
|
