|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$15,377.28
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$10,434.58 |
| Max. Negotiated Rate |
$15,377.28 |
| Rate for Payer: Anthem Medicaid |
$10,434.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,983.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,377.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,828.09
|
| Rate for Payer: Humana KY Medicaid |
$10,434.58
|
| Rate for Payer: Humana Medicare Advantage |
$10,983.77
|
| Rate for Payer: Kentucky WC Medicaid |
$10,538.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,180.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,643.27
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$9,015.79
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$6,117.86 |
| Max. Negotiated Rate |
$9,015.79 |
| Rate for Payer: Anthem Medicaid |
$6,117.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,439.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,015.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,693.80
|
| Rate for Payer: Humana KY Medicaid |
$6,117.86
|
| Rate for Payer: Humana Medicare Advantage |
$6,439.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,179.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,727.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,240.21
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
IP
|
$28.72
|
|
|
Service Code
|
NDC 60505325006
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$27.57 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.40
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna Commercial |
$23.84
|
| Rate for Payer: First Health Commercial |
$27.28
|
| Rate for Payer: Humana Commercial |
$24.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.27
|
| Rate for Payer: Ohio Health Group HMO |
$21.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.90
|
| Rate for Payer: PHCS Commercial |
$27.57
|
| Rate for Payer: United Healthcare All Payer |
$25.27
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
OP
|
$9.25
|
|
|
Service Code
|
NDC 33342000109
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$3.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna Commercial |
$7.68
|
| Rate for Payer: First Health Commercial |
$8.79
|
| Rate for Payer: Humana Commercial |
$7.86
|
| Rate for Payer: Humana KY Medicaid |
$3.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.14
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
OP
|
$28.72
|
|
|
Service Code
|
NDC 60505325006
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$27.57 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Anthem Medicaid |
$9.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22.40
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna Commercial |
$23.84
|
| Rate for Payer: First Health Commercial |
$27.28
|
| Rate for Payer: Humana Commercial |
$24.41
|
| Rate for Payer: Humana KY Medicaid |
$9.88
|
| Rate for Payer: Kentucky WC Medicaid |
$9.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$25.27
|
| Rate for Payer: Ohio Health Group HMO |
$21.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.90
|
| Rate for Payer: PHCS Commercial |
$27.57
|
| Rate for Payer: United Healthcare All Payer |
$25.27
|
|
|
EPIVAR(LAMIVUDINE)150MG/1TAB
|
Facility
|
IP
|
$9.25
|
|
|
Service Code
|
NDC 33342000109
|
| Hospital Charge Code |
25000625
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$8.88 |
| Rate for Payer: Aetna Commercial |
$7.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.22
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cigna Commercial |
$7.68
|
| Rate for Payer: First Health Commercial |
$8.79
|
| Rate for Payer: Humana Commercial |
$7.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.14
|
| Rate for Payer: Ohio Health Group HMO |
$6.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.87
|
| Rate for Payer: PHCS Commercial |
$8.88
|
| Rate for Payer: United Healthcare All Payer |
$8.14
|
|
|
EPLEY MANEUVER
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
EPLEY MANEUVER
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
42000004
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Aetna Commercial |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$38.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.14
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$93.79
|
| Rate for Payer: First Health Commercial |
$107.35
|
| Rate for Payer: Humana Commercial |
$96.05
|
| Rate for Payer: Humana KY Medicaid |
$38.86
|
| Rate for Payer: Kentucky WC Medicaid |
$39.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.44
|
| Rate for Payer: Ohio Health Group HMO |
$84.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.03
|
| Rate for Payer: PHCS Commercial |
$108.48
|
| Rate for Payer: United Healthcare All Payer |
$99.44
|
|
|
EPLVIR 300MG EQUIV TABLET
|
Facility
|
OP
|
$10.50
|
|
|
Service Code
|
NDC 33342000207
|
| Hospital Charge Code |
25003046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Anthem Medicaid |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.19
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cigna Commercial |
$8.72
|
| Rate for Payer: First Health Commercial |
$9.98
|
| Rate for Payer: Humana Commercial |
$8.92
|
| Rate for Payer: Humana KY Medicaid |
$3.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.26
|
| Rate for Payer: PHCS Commercial |
$10.08
|
| Rate for Payer: United Healthcare All Payer |
$9.24
|
|
|
EPLVIR 300MG EQUIV TABLET
|
Facility
|
IP
|
$10.50
|
|
|
Service Code
|
NDC 33342000207
|
| Hospital Charge Code |
25003046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.19
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Cigna Commercial |
$8.72
|
| Rate for Payer: First Health Commercial |
$9.98
|
| Rate for Payer: Humana Commercial |
$8.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.26
|
| Rate for Payer: PHCS Commercial |
$10.08
|
| Rate for Payer: United Healthcare All Payer |
$9.24
|
|
|
EPSOM SALT CRYSTALS 454 GM
|
Facility
|
OP
|
$5.02
|
|
|
Service Code
|
NDC 869060243
|
| Hospital Charge Code |
25000626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.82 |
| 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 |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| 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 |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
EPSOM SALT CRYSTALS 454 GM
|
Facility
|
IP
|
$5.02
|
|
|
Service Code
|
NDC 869060243
|
| Hospital Charge Code |
25000626
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.77
|
| Rate for Payer: Humana Commercial |
$4.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.42
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.00
|
| 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 |
$4.82
|
| Rate for Payer: United Healthcare All Payer |
$4.42
|
|
|
EQUINOXE GLENOID KEEL ALPHA L
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA L
|
Facility
|
OP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem Medicaid |
$2,804.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Humana KY Medicaid |
$2,804.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,832.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA M
|
Facility
|
OP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem Medicaid |
$2,804.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Humana KY Medicaid |
$2,804.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,832.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA M
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA S
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA S
|
Facility
|
OP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem Medicaid |
$2,804.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Humana KY Medicaid |
$2,804.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,832.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA L
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA L
|
Facility
|
OP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem Medicaid |
$2,804.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Humana KY Medicaid |
$2,804.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,832.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA M
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA M
|
Facility
|
OP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem Medicaid |
$2,804.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Humana KY Medicaid |
$2,804.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,832.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA S
|
Facility
|
OP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem Medicaid |
$2,804.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Humana KY Medicaid |
$2,804.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,832.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,860.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA S
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
|
EQUINOXE GLENOID KEEL BETA XL
|
Facility
|
IP
|
$8,154.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.09 |
| Max. Negotiated Rate |
$7,828.37 |
| Rate for Payer: Aetna Commercial |
$6,279.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,360.55
|
| Rate for Payer: Cash Price |
$4,077.28
|
| Rate for Payer: Cigna Commercial |
$6,768.28
|
| Rate for Payer: First Health Commercial |
$7,746.82
|
| Rate for Payer: Humana Commercial |
$6,931.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,686.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,018.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,176.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,115.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,527.91
|
| Rate for Payer: PHCS Commercial |
$7,828.37
|
| Rate for Payer: United Healthcare All Payer |
$7,176.00
|
|
