|
EQUINOXE GLENOID KEEL BETA XL
|
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 PEG 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 PEG 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 PEG 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 PEG 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 PEG 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 PEG 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 PEG BETA L
|
Facility
|
OP
|
$10,871.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.35 |
| Max. Negotiated Rate |
$10,437.04 |
| Rate for Payer: Aetna Commercial |
$8,371.38
|
| Rate for Payer: Anthem Medicaid |
$3,738.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,480.10
|
| Rate for Payer: Cash Price |
$5,435.96
|
| Rate for Payer: Cigna Commercial |
$9,023.69
|
| Rate for Payer: First Health Commercial |
$10,328.32
|
| Rate for Payer: Humana Commercial |
$9,241.13
|
| Rate for Payer: Humana KY Medicaid |
$3,738.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,776.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,914.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,023.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,261.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,813.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,567.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,153.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,174.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,413.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,370.30
|
| Rate for Payer: PHCS Commercial |
$10,437.04
|
| Rate for Payer: United Healthcare All Payer |
$9,567.29
|
|
|
EQUINOXE GLENOID PEG BETA L
|
Facility
|
IP
|
$10,871.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.35 |
| Max. Negotiated Rate |
$10,437.04 |
| Rate for Payer: Aetna Commercial |
$8,371.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,480.10
|
| Rate for Payer: Cash Price |
$5,435.96
|
| Rate for Payer: Cigna Commercial |
$9,023.69
|
| Rate for Payer: First Health Commercial |
$10,328.32
|
| Rate for Payer: Humana Commercial |
$9,241.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,914.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,023.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,261.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,567.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,153.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,174.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,413.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,370.30
|
| Rate for Payer: PHCS Commercial |
$10,437.04
|
| Rate for Payer: United Healthcare All Payer |
$9,567.29
|
|
|
EQUINOXE GLENOID PEG BETA M
|
Facility
|
IP
|
$9,311.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.51 |
| Max. Negotiated Rate |
$8,939.14 |
| Rate for Payer: Aetna Commercial |
$7,169.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,263.05
|
| Rate for Payer: Cash Price |
$4,655.80
|
| Rate for Payer: Cigna Commercial |
$7,728.63
|
| Rate for Payer: First Health Commercial |
$8,846.02
|
| Rate for Payer: Humana Commercial |
$7,914.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,635.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,871.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,793.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,194.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,983.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,862.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,886.60
|
| Rate for Payer: PHCS Commercial |
$8,939.14
|
| Rate for Payer: United Healthcare All Payer |
$8,194.21
|
|
|
EQUINOXE GLENOID PEG BETA M
|
Facility
|
OP
|
$9,311.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.51 |
| Max. Negotiated Rate |
$8,939.14 |
| Rate for Payer: Aetna Commercial |
$7,169.93
|
| Rate for Payer: Anthem Medicaid |
$3,202.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,263.05
|
| Rate for Payer: Cash Price |
$4,655.80
|
| Rate for Payer: Cigna Commercial |
$7,728.63
|
| Rate for Payer: First Health Commercial |
$8,846.02
|
| Rate for Payer: Humana Commercial |
$7,914.86
|
| Rate for Payer: Humana KY Medicaid |
$3,202.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,234.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,635.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,871.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,793.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,266.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,194.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,983.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,862.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,886.60
|
| Rate for Payer: PHCS Commercial |
$8,939.14
|
| Rate for Payer: United Healthcare All Payer |
$8,194.21
|
|
|
EQUINOXE GLENOID PEG 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 PEG 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 PEG 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
|
|
|
EQUINOXE GLENOID PEG BETA XL
|
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 HUMERAL TRAY +15MM
|
Facility
|
OP
|
$11,366.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.64 |
| Max. Negotiated Rate |
$10,911.84 |
| Rate for Payer: Aetna Commercial |
$8,752.20
|
| Rate for Payer: Anthem Medicaid |
$3,908.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,865.87
|
| Rate for Payer: Cash Price |
$5,683.25
|
| Rate for Payer: Cigna Commercial |
$9,434.20
|
| Rate for Payer: First Health Commercial |
$10,798.18
|
| Rate for Payer: Humana Commercial |
$9,661.52
|
| Rate for Payer: Humana KY Medicaid |
$3,908.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,948.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,320.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,388.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,409.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,002.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,524.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,273.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,523.62
|
| Rate for Payer: PHCS Commercial |
$10,911.84
|
| Rate for Payer: United Healthcare All Payer |
$10,002.52
|
|
|
EQUINOXE HUMERAL TRAY +15MM
|
Facility
|
IP
|
$11,366.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.64 |
| Max. Negotiated Rate |
$10,911.84 |
| Rate for Payer: Aetna Commercial |
$8,752.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,865.87
|
| Rate for Payer: Cash Price |
$5,683.25
|
| Rate for Payer: Cigna Commercial |
$9,434.20
|
| Rate for Payer: First Health Commercial |
$10,798.18
|
| Rate for Payer: Humana Commercial |
$9,661.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,320.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,388.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,409.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,002.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,524.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,273.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,523.62
|
| Rate for Payer: PHCS Commercial |
$10,911.84
|
| Rate for Payer: United Healthcare All Payer |
$10,002.52
|
|
|
EQUINOXE HUM HEAD EXPANDD 47MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 47MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 50MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 50MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 53MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 53MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 38MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 38MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
