|
EVISTA (RALOXIFENE) 60MG TAB
|
Facility
|
OP
|
$9.16
|
|
|
Service Code
|
NDC 65862070901
|
| Hospital Charge Code |
25000642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: First Health Commercial |
$8.70
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.06
|
| Rate for Payer: Ohio Health Group HMO |
$6.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.79
|
| Rate for Payer: United Healthcare All Payer |
$8.06
|
|
|
EVISTA (RALOXIFENE) 60MG TAB
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 65862070901
|
| Hospital Charge Code |
25000642
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Aetna Commercial |
$7.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: First Health Commercial |
$8.70
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.06
|
| Rate for Payer: Ohio Health Group HMO |
$6.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.79
|
| Rate for Payer: United Healthcare All Payer |
$8.06
|
|
|
EVOKED OTOACOUSTIC EMISS LIMI
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
47000018
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.97
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
EVOKED OTOACOUSTIC EMISS LIMI
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
47000018
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem Medicaid |
$167.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Humana KY Medicaid |
$167.48
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$169.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.97
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
EVOKED OTOACOUSTIC EMISS LIMI
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
47000018
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Anthem Medicaid |
$43.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$487.00
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$81.56
|
| Rate for Payer: Healthspan PPO |
$49.05
|
| Rate for Payer: Humana Medicaid |
$43.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.04
|
| Rate for Payer: Molina Healthcare Passport |
$43.18
|
| Rate for Payer: Multiplan PHCS |
$292.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$340.90
|
| Rate for Payer: UHCCP Medicaid |
$170.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.61
|
|
|
EVOKED OTOACOUSTIC EMISS LIM(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
470P0018
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$59.93
|
| Rate for Payer: Anthem Medicaid |
$43.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$81.56
|
| Rate for Payer: Healthspan PPO |
$49.05
|
| Rate for Payer: Humana Medicaid |
$43.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.04
|
| Rate for Payer: Molina Healthcare Passport |
$43.18
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.61
|
|
|
EVOKED OTOACOUSTIC EMISS LIM(T
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
470T0018
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$133.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$133.09
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
EVOKED OTOACOUSTIC EMISS LIM(T
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 92587
|
| Hospital Charge Code |
470T0018
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
EVOL CAN FILL STEM 17MM*100MM
|
Facility
|
OP
|
$8,096.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.50 |
| Max. Negotiated Rate |
$7,772.30 |
| Rate for Payer: Aetna Commercial |
$6,234.04
|
| Rate for Payer: Anthem Medicaid |
$2,784.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.00
|
| Rate for Payer: Cash Price |
$4,048.07
|
| Rate for Payer: Cigna Commercial |
$6,719.80
|
| Rate for Payer: First Health Commercial |
$7,691.34
|
| Rate for Payer: Humana Commercial |
$6,881.73
|
| Rate for Payer: Humana KY Medicaid |
$2,784.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,812.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,638.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,974.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,428.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,840.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,124.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,509.81
|
| Rate for Payer: PHCS Commercial |
$7,772.30
|
| Rate for Payer: United Healthcare All Payer |
$7,124.61
|
|
|
EVOL CAN FILL STEM 17MM*100MM
|
Facility
|
IP
|
$8,096.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.50 |
| Max. Negotiated Rate |
$7,772.30 |
| Rate for Payer: Aetna Commercial |
$6,234.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.00
|
| Rate for Payer: Cash Price |
$4,048.07
|
| Rate for Payer: Cigna Commercial |
$6,719.80
|
| Rate for Payer: First Health Commercial |
$7,691.34
|
| Rate for Payer: Humana Commercial |
$6,881.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,638.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,974.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,428.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,124.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,509.81
|
| Rate for Payer: PHCS Commercial |
$7,772.30
|
| Rate for Payer: United Healthcare All Payer |
$7,124.61
|
|
|
EVOL TIB AUG SZ 4MD RIGHT*10MM
|
Facility
|
OP
|
$8,132.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.24 |
| Max. Negotiated Rate |
$7,807.34 |
| Rate for Payer: Aetna Commercial |
$6,262.14
|
| Rate for Payer: Anthem Medicaid |
$2,796.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,343.47
|
| Rate for Payer: Cash Price |
$4,066.32
|
| Rate for Payer: Cigna Commercial |
$6,750.10
|
| Rate for Payer: First Health Commercial |
$7,726.02
|
| Rate for Payer: Humana Commercial |
$6,912.75
|
| Rate for Payer: Humana KY Medicaid |
$2,796.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,825.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,668.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,001.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,852.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,156.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,099.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,521.12
|
| Rate for Payer: PHCS Commercial |
$7,807.34
|
| Rate for Payer: United Healthcare All Payer |
$7,156.73
|
|
|
EVOL TIB AUG SZ 4MD RIGHT*10MM
|
Facility
|
IP
|
$8,132.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,057.24 |
| Max. Negotiated Rate |
$7,807.34 |
| Rate for Payer: Aetna Commercial |
$6,262.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,343.47
|
| Rate for Payer: Cash Price |
$4,066.32
|
| Rate for Payer: Cigna Commercial |
$6,750.10
|
| Rate for Payer: First Health Commercial |
$7,726.02
|
| Rate for Payer: Humana Commercial |
$6,912.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,668.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,001.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,439.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,156.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,099.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,521.12
|
| Rate for Payer: PHCS Commercial |
$7,807.34
|
| Rate for Payer: United Healthcare All Payer |
$7,156.73
|
|
|
EVOLUTION CMENTED STEM 17*50MM
|
Facility
|
OP
|
$6,873.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.54 |
| Max. Negotiated Rate |
$6,598.46 |
| Rate for Payer: Aetna Commercial |
$5,292.52
|
| Rate for Payer: Anthem Medicaid |
$2,363.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,361.25
|
| Rate for Payer: Cash Price |
$3,436.70
|
| Rate for Payer: Cigna Commercial |
$5,704.92
|
| Rate for Payer: First Health Commercial |
$6,529.73
|
| Rate for Payer: Humana Commercial |
$5,842.39
|
| Rate for Payer: Humana KY Medicaid |
$2,363.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,387.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,636.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,072.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,062.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,411.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,048.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,155.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,374.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$893.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.75
|
| Rate for Payer: PHCS Commercial |
$6,598.46
|
| Rate for Payer: United Healthcare All Payer |
$6,048.59
|
|
|
EVOLUTION CMENTED STEM 17*50MM
|
Facility
|
IP
|
$6,873.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.54 |
| Max. Negotiated Rate |
$6,598.46 |
| Rate for Payer: Aetna Commercial |
$5,292.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,361.25
|
| Rate for Payer: Cash Price |
$3,436.70
|
| Rate for Payer: Cigna Commercial |
$5,704.92
|
| Rate for Payer: First Health Commercial |
$6,529.73
|
| Rate for Payer: Humana Commercial |
$5,842.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,636.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,072.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,062.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,048.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,155.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,374.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$893.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.75
|
| Rate for Payer: PHCS Commercial |
$6,598.46
|
| Rate for Payer: United Healthcare All Payer |
$6,048.59
|
|
|
EVOLUTION CR INSRT S4 STD 10M
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CR INSRT S4 STD 10M
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CR INSRT S6 STD 12M
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CR INSRT S6 STD 12M
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CR INSRT S8 STD 14M
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CR INSRT S8 STD 14M
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CS INSRT S2 PLUS 10M
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CS INSRT S2 PLUS 10M
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CS INSRT S3 PLUS 14M
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CS INSRT S3 PLUS 14M
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
EVOLUTION CS INSRT S3 STD 10M
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
