|
HII SS CONNECTING ROD 8*250MM
|
Facility
|
OP
|
$1,070.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$1,027.35 |
| Rate for Payer: Aetna Commercial |
$824.02
|
| Rate for Payer: Anthem Medicaid |
$368.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.72
|
| Rate for Payer: Cash Price |
$535.08
|
| Rate for Payer: Cigna Commercial |
$888.23
|
| Rate for Payer: First Health Commercial |
$1,016.65
|
| Rate for Payer: Humana Commercial |
$909.64
|
| Rate for Payer: Humana KY Medicaid |
$368.03
|
| Rate for Payer: Kentucky WC Medicaid |
$371.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.74
|
| Rate for Payer: Ohio Health Group HMO |
$802.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.75
|
| Rate for Payer: PHCS Commercial |
$1,027.35
|
| Rate for Payer: United Healthcare All Payer |
$941.74
|
|
|
HII SS CONNECTING ROD 8*300MM
|
Facility
|
OP
|
$1,070.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$1,027.35 |
| Rate for Payer: Aetna Commercial |
$824.02
|
| Rate for Payer: Anthem Medicaid |
$368.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.72
|
| Rate for Payer: Cash Price |
$535.08
|
| Rate for Payer: Cigna Commercial |
$888.23
|
| Rate for Payer: First Health Commercial |
$1,016.65
|
| Rate for Payer: Humana Commercial |
$909.64
|
| Rate for Payer: Humana KY Medicaid |
$368.03
|
| Rate for Payer: Kentucky WC Medicaid |
$371.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.74
|
| Rate for Payer: Ohio Health Group HMO |
$802.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.75
|
| Rate for Payer: PHCS Commercial |
$1,027.35
|
| Rate for Payer: United Healthcare All Payer |
$941.74
|
|
|
HII SS CONNECTING ROD 8*300MM
|
Facility
|
IP
|
$1,070.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$1,027.35 |
| Rate for Payer: Aetna Commercial |
$824.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.72
|
| Rate for Payer: Cash Price |
$535.08
|
| Rate for Payer: Cigna Commercial |
$888.23
|
| Rate for Payer: First Health Commercial |
$1,016.65
|
| Rate for Payer: Humana Commercial |
$909.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.74
|
| Rate for Payer: Ohio Health Group HMO |
$802.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.75
|
| Rate for Payer: PHCS Commercial |
$1,027.35
|
| Rate for Payer: United Healthcare All Payer |
$941.74
|
|
|
HII SS CONNECTING ROD 8*350MM
|
Facility
|
IP
|
$1,070.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$1,027.35 |
| Rate for Payer: Aetna Commercial |
$824.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.72
|
| Rate for Payer: Cash Price |
$535.08
|
| Rate for Payer: Cigna Commercial |
$888.23
|
| Rate for Payer: First Health Commercial |
$1,016.65
|
| Rate for Payer: Humana Commercial |
$909.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.74
|
| Rate for Payer: Ohio Health Group HMO |
$802.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.75
|
| Rate for Payer: PHCS Commercial |
$1,027.35
|
| Rate for Payer: United Healthcare All Payer |
$941.74
|
|
|
HII SS CONNECTING ROD 8*350MM
|
Facility
|
OP
|
$1,070.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$1,027.35 |
| Rate for Payer: Aetna Commercial |
$824.02
|
| Rate for Payer: Anthem Medicaid |
$368.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.72
|
| Rate for Payer: Cash Price |
$535.08
|
| Rate for Payer: Cigna Commercial |
$888.23
|
| Rate for Payer: First Health Commercial |
$1,016.65
|
| Rate for Payer: Humana Commercial |
$909.64
|
| Rate for Payer: Humana KY Medicaid |
$368.03
|
| Rate for Payer: Kentucky WC Medicaid |
$371.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.74
|
| Rate for Payer: Ohio Health Group HMO |
$802.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.75
|
| Rate for Payer: PHCS Commercial |
$1,027.35
|
| Rate for Payer: United Healthcare All Payer |
$941.74
|
|
|
HII SS CONNECTING ROD 8*400MM
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem Medicaid |
$375.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Humana KY Medicaid |
$375.13
|
| Rate for Payer: Kentucky WC Medicaid |
$378.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
HII SS CONNECTING ROD 8*400MM
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
HII SS CONNECTING ROD 8*450MM
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem Medicaid |
$375.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Humana KY Medicaid |
$375.13
|
| Rate for Payer: Kentucky WC Medicaid |
$378.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
HII SS CONNECTING ROD 8*450MM
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
HII SS CONNECTING ROD 8*500MM
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem Medicaid |
$375.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Humana KY Medicaid |
$375.13
|
| Rate for Payer: Kentucky WC Medicaid |
$378.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
HII SS CONNECTING ROD 8*500MM
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
HII SS CONNECTING ROD 8*65MM
|
Facility
|
IP
|
$808.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.14 |
| Max. Negotiated Rate |
$776.45 |
| Rate for Payer: Aetna Commercial |
$622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.86
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$671.30
|
| Rate for Payer: First Health Commercial |
$768.36
|
| Rate for Payer: Humana Commercial |
$687.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.74
|
| Rate for Payer: Ohio Health Group HMO |
$606.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.73
|
| Rate for Payer: PHCS Commercial |
$776.45
|
| Rate for Payer: United Healthcare All Payer |
$711.74
|
|
|
HII SS CONNECTING ROD 8*65MM
|
Facility
|
OP
|
$808.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.14 |
| Max. Negotiated Rate |
$776.45 |
| Rate for Payer: Aetna Commercial |
$622.78
|
| Rate for Payer: Anthem Medicaid |
$278.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.86
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$671.30
|
| Rate for Payer: First Health Commercial |
$768.36
|
| Rate for Payer: Humana Commercial |
$687.48
|
| Rate for Payer: Humana KY Medicaid |
$278.15
|
| Rate for Payer: Kentucky WC Medicaid |
$280.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.74
|
| Rate for Payer: Ohio Health Group HMO |
$606.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.73
|
| Rate for Payer: PHCS Commercial |
$776.45
|
| Rate for Payer: United Healthcare All Payer |
$711.74
|
|
|
HINGE COMPASS UNIVERSAL
|
Facility
|
OP
|
$28,695.09
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,730.36 |
| Max. Negotiated Rate |
$27,547.29 |
| Rate for Payer: Aetna Commercial |
$22,095.22
|
| Rate for Payer: Anthem Medicaid |
$9,868.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,382.17
|
| Rate for Payer: Cash Price |
$14,347.54
|
| Rate for Payer: Cigna Commercial |
$23,816.92
|
| Rate for Payer: First Health Commercial |
$27,260.34
|
| Rate for Payer: Humana Commercial |
$24,390.83
|
| Rate for Payer: Humana KY Medicaid |
$9,868.24
|
| Rate for Payer: Kentucky WC Medicaid |
$9,968.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,529.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,176.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,608.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,066.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,251.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,521.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,739.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,895.48
|
| Rate for Payer: PHCS Commercial |
$27,547.29
|
| Rate for Payer: United Healthcare All Payer |
$25,251.68
|
|
|
HINGE COMPASS UNIVERSAL
|
Facility
|
IP
|
$28,695.09
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,730.36 |
| Max. Negotiated Rate |
$27,547.29 |
| Rate for Payer: Aetna Commercial |
$22,095.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,382.17
|
| Rate for Payer: Cash Price |
$14,347.54
|
| Rate for Payer: Cigna Commercial |
$23,816.92
|
| Rate for Payer: First Health Commercial |
$27,260.34
|
| Rate for Payer: Humana Commercial |
$24,390.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,529.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,176.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,608.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,251.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,521.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,739.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,730.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,895.48
|
| Rate for Payer: PHCS Commercial |
$27,547.29
|
| Rate for Payer: United Healthcare All Payer |
$25,251.68
|
|
|
HINGE NXGN ROTART SUR B 12 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 12 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 14 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 14 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 17 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 17 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 20 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 20 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 23 MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HINGE NXGN ROTART SUR B 23 MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
