|
EQUINOXE GLENOID KEEL ALPHA L
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA M
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA M
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA S
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL ALPHA S
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA L
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA L
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA M
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA M
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA S
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA S
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA XL
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID KEEL BETA XL
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG ALPHA L
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG ALPHA L
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG ALPHA M
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG ALPHA M
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG ALPHA S
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG ALPHA S
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG BETA L
|
Facility
|
IP
|
$11,113.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,334.03 |
| Max. Negotiated Rate |
$10,668.88 |
| Rate for Payer: Aetna Commercial |
$8,557.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.47
|
| Rate for Payer: Cash Price |
$5,556.71
|
| Rate for Payer: Cigna Commercial |
$9,224.14
|
| Rate for Payer: First Health Commercial |
$10,557.75
|
| Rate for Payer: Humana Commercial |
$9,446.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,201.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,779.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,890.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,668.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,668.26
|
| Rate for Payer: PHCS Commercial |
$10,668.88
|
| Rate for Payer: United Healthcare All Payer |
$9,779.81
|
|
|
EQUINOXE GLENOID PEG BETA L
|
Facility
|
OP
|
$11,113.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,334.03 |
| Max. Negotiated Rate |
$10,668.88 |
| Rate for Payer: Aetna Commercial |
$8,557.33
|
| Rate for Payer: Anthem Medicaid |
$3,821.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,668.47
|
| Rate for Payer: Cash Price |
$5,556.71
|
| Rate for Payer: Cigna Commercial |
$9,224.14
|
| Rate for Payer: First Health Commercial |
$10,557.75
|
| Rate for Payer: Humana Commercial |
$9,446.41
|
| Rate for Payer: Humana KY Medicaid |
$3,821.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,860.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,113.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,201.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,898.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,779.81
|
| Rate for Payer: Ohio Health Group HMO |
$8,335.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,890.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,668.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,668.26
|
| Rate for Payer: PHCS Commercial |
$10,668.88
|
| Rate for Payer: United Healthcare All Payer |
$9,779.81
|
|
|
EQUINOXE GLENOID PEG BETA M
|
Facility
|
IP
|
$9,511.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.48 |
| Max. Negotiated Rate |
$9,131.14 |
| Rate for Payer: Aetna Commercial |
$7,323.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.05
|
| Rate for Payer: Cash Price |
$4,755.80
|
| Rate for Payer: Cigna Commercial |
$7,894.63
|
| Rate for Payer: First Health Commercial |
$9,036.02
|
| Rate for Payer: Humana Commercial |
$8,084.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,609.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,275.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,563.00
|
| Rate for Payer: PHCS Commercial |
$9,131.14
|
| Rate for Payer: United Healthcare All Payer |
$8,370.21
|
|
|
EQUINOXE GLENOID PEG BETA M
|
Facility
|
OP
|
$9,511.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.48 |
| Max. Negotiated Rate |
$9,131.14 |
| Rate for Payer: Aetna Commercial |
$7,323.93
|
| Rate for Payer: Anthem Medicaid |
$3,271.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.05
|
| Rate for Payer: Cash Price |
$4,755.80
|
| Rate for Payer: Cigna Commercial |
$7,894.63
|
| Rate for Payer: First Health Commercial |
$9,036.02
|
| Rate for Payer: Humana Commercial |
$8,084.86
|
| Rate for Payer: Humana KY Medicaid |
$3,271.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,304.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,336.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.21
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,609.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,275.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,563.00
|
| Rate for Payer: PHCS Commercial |
$9,131.14
|
| Rate for Payer: United Healthcare All Payer |
$8,370.21
|
|
|
EQUINOXE GLENOID PEG BETA S
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG BETA S
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
