|
VASOTEC 2.5 MG/2 ML VIAL
|
Facility
|
OP
|
$116.48
|
|
|
Service Code
|
NDC 143978610
|
| Hospital Charge Code |
25003564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$111.82 |
| Rate for Payer: Humana Commercial |
$99.01
|
| Rate for Payer: Humana KY Medicaid |
$40.06
|
| Rate for Payer: Kentucky WC Medicaid |
$40.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.50
|
| Rate for Payer: Ohio Health Group HMO |
$87.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.11
|
| Rate for Payer: PHCS Commercial |
$111.82
|
| Rate for Payer: United Healthcare All Payer |
$102.50
|
| Rate for Payer: Aetna Commercial |
$89.69
|
| Rate for Payer: Anthem Medicaid |
$40.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$90.85
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cigna Commercial |
$96.68
|
| Rate for Payer: First Health Commercial |
$110.66
|
|
|
VASOTEC (ENALAPRIL) 10MG/1TAB
|
Facility
|
IP
|
$4.78
|
|
|
Service Code
|
NDC 68682071201
|
| Hospital Charge Code |
25001653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
VASOTEC (ENALAPRIL) 10MG/1TAB
|
Facility
|
OP
|
$4.78
|
|
|
Service Code
|
NDC 68682071201
|
| Hospital Charge Code |
25001653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
VASOTEC (ENALAPRIL) 1.25MG/ML
|
Facility
|
IP
|
$112.31
|
|
|
Service Code
|
NDC 143978701
|
| Hospital Charge Code |
25003563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$107.82 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.60
|
| Rate for Payer: Cash Price |
$56.16
|
| Rate for Payer: Cigna Commercial |
$93.22
|
| Rate for Payer: First Health Commercial |
$106.69
|
| Rate for Payer: Humana Commercial |
$95.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.83
|
| Rate for Payer: Ohio Health Group HMO |
$84.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.82
|
| Rate for Payer: PHCS Commercial |
$107.82
|
| Rate for Payer: United Healthcare All Payer |
$98.83
|
|
|
VASOTEC (ENALAPRIL) 1.25MG/ML
|
Facility
|
OP
|
$112.31
|
|
|
Service Code
|
NDC 143978701
|
| Hospital Charge Code |
25003563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$107.82 |
| Rate for Payer: Aetna Commercial |
$86.48
|
| Rate for Payer: Anthem Medicaid |
$38.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.60
|
| Rate for Payer: Cash Price |
$56.16
|
| Rate for Payer: Cigna Commercial |
$93.22
|
| Rate for Payer: First Health Commercial |
$106.69
|
| Rate for Payer: Humana Commercial |
$95.46
|
| Rate for Payer: Humana KY Medicaid |
$38.62
|
| Rate for Payer: Kentucky WC Medicaid |
$39.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.83
|
| Rate for Payer: Ohio Health Group HMO |
$84.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.82
|
| Rate for Payer: PHCS Commercial |
$107.82
|
| Rate for Payer: United Healthcare All Payer |
$98.83
|
|
|
VASOTEC (ENALAPRIL) 20MG/1TAB
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 68682071301
|
| Hospital Charge Code |
25001654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
VASOTEC (ENALAPRIL) 20MG/1TAB
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 68682071301
|
| Hospital Charge Code |
25001654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
VASOTEC (ENALAPRIL) 2.5MG/1TAB
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 68682071001
|
| Hospital Charge Code |
25001655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
VASOTEC (ENALAPRIL) 2.5MG/1TAB
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 68682071001
|
| Hospital Charge Code |
25001655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.85
|
| Rate for Payer: First Health Commercial |
$4.41
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.08
|
| Rate for Payer: Ohio Health Group HMO |
$3.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.45
|
| Rate for Payer: United Healthcare All Payer |
$4.08
|
|
|
VASOTEC (ENALAPRIL) 5 5MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 51672403801
|
| Hospital Charge Code |
25001656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
VASOTEC (ENALAPRIL) 5 5MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 51672403801
|
| Hospital Charge Code |
25001656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
VAULT LOCK GLENOID LG
|
Facility
|
OP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem Medicaid |
$2,939.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Humana KY Medicaid |
$2,939.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID LG
|
Facility
|
IP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID MD
|
Facility
|
IP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID MD
|
Facility
|
OP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem Medicaid |
$2,939.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Humana KY Medicaid |
$2,939.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID SMALL
|
Facility
|
IP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID SMALL
|
Facility
|
OP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem Medicaid |
$2,939.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Humana KY Medicaid |
$2,939.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID XLG
|
Facility
|
IP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAULT LOCK GLENOID XLG
|
Facility
|
OP
|
$8,548.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,111.34 |
| Max. Negotiated Rate |
$8,206.80 |
| Rate for Payer: Aetna Commercial |
$6,582.54
|
| Rate for Payer: Anthem Medicaid |
$2,939.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.02
|
| Rate for Payer: Cash Price |
$4,274.38
|
| Rate for Payer: Cigna Commercial |
$7,095.46
|
| Rate for Payer: First Health Commercial |
$8,121.31
|
| Rate for Payer: Humana Commercial |
$7,266.44
|
| Rate for Payer: Humana KY Medicaid |
$2,939.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,111.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,650.11
|
| Rate for Payer: PHCS Commercial |
$8,206.80
|
| Rate for Payer: United Healthcare All Payer |
$7,522.90
|
|
|
VAXCEL W/PASV PORT MINI 6FR
|
Facility
|
IP
|
$4,443.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.66 |
| Max. Negotiated Rate |
$4,265.76 |
| Rate for Payer: Aetna Commercial |
$3,421.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,465.93
|
| Rate for Payer: Cash Price |
$2,221.75
|
| Rate for Payer: Cigna Commercial |
$3,688.10
|
| Rate for Payer: First Health Commercial |
$4,221.32
|
| Rate for Payer: Humana Commercial |
$3,776.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,643.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,279.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,910.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$888.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.48
|
| Rate for Payer: PHCS Commercial |
$4,265.76
|
| Rate for Payer: United Healthcare All Payer |
$3,910.28
|
|
|
VAXCEL W/PASV PORT MINI 6FR
|
Facility
|
OP
|
$4,443.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.66 |
| Max. Negotiated Rate |
$4,265.76 |
| Rate for Payer: Aetna Commercial |
$3,421.50
|
| Rate for Payer: Anthem Medicaid |
$1,528.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,465.93
|
| Rate for Payer: Cash Price |
$2,221.75
|
| Rate for Payer: Cigna Commercial |
$3,688.10
|
| Rate for Payer: First Health Commercial |
$4,221.32
|
| Rate for Payer: Humana Commercial |
$3,776.98
|
| Rate for Payer: Humana KY Medicaid |
$1,528.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,543.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,643.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,279.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,558.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,910.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,332.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$888.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.48
|
| Rate for Payer: PHCS Commercial |
$4,265.76
|
| Rate for Payer: United Healthcare All Payer |
$3,910.28
|
|
|
VAXNEUVANCE (PCV15) VACCINE
|
Facility
|
IP
|
$663.61
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
25004286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.27 |
| Max. Negotiated Rate |
$637.07 |
| Rate for Payer: Aetna Commercial |
$510.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.62
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$630.43
|
| Rate for Payer: Humana Commercial |
$564.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$489.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$583.98
|
| Rate for Payer: Ohio Health Group HMO |
$497.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.72
|
| Rate for Payer: PHCS Commercial |
$637.07
|
| Rate for Payer: United Healthcare All Payer |
$583.98
|
|
|
VAXNEUVANCE (PCV15) VACCINE
|
Facility
|
OP
|
$663.61
|
|
|
Service Code
|
HCPCS 90671
|
| Hospital Charge Code |
25004286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.27 |
| Max. Negotiated Rate |
$637.07 |
| Rate for Payer: Aetna Commercial |
$510.98
|
| Rate for Payer: Anthem Medicaid |
$228.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.62
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$550.80
|
| Rate for Payer: First Health Commercial |
$630.43
|
| Rate for Payer: Humana Commercial |
$564.07
|
| Rate for Payer: Humana KY Medicaid |
$228.22
|
| Rate for Payer: Kentucky WC Medicaid |
$230.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$489.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$583.98
|
| Rate for Payer: Ohio Health Group HMO |
$497.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.72
|
| Rate for Payer: PHCS Commercial |
$637.07
|
| Rate for Payer: United Healthcare All Payer |
$583.98
|
|
|
VBAC CARE AFTER DELIVERY
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
761P2614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$1,677.53 |
| Rate for Payer: Aetna Commercial |
$1,623.34
|
| Rate for Payer: Anthem Medicaid |
$900.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,380.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,497.28
|
| Rate for Payer: Healthspan PPO |
$1,178.25
|
| Rate for Payer: Humana Medicaid |
$900.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,677.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.00
|
| Rate for Payer: Molina Healthcare Passport |
$900.00
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$966.00
|
| Rate for Payer: UHCCP Medicaid |
$483.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.00
|
|
|
VBAC CARE AFTER DELIVERY
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
76102614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem Medicaid |
$474.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Humana KY Medicaid |
$474.58
|
| Rate for Payer: Kentucky WC Medicaid |
$479.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
