|
RADIAL HEAD CONSTRUCT 24MM*12M
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HEAD CONSTRUCT 24MM*12M
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HEAD ENDO M 12MM
|
Facility
|
OP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem Medicaid |
$5,554.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Humana KY Medicaid |
$5,554.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,611.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,666.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO M 12MM
|
Facility
|
IP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO M 15MM
|
Facility
|
IP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO M 15MM
|
Facility
|
OP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem Medicaid |
$5,554.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Humana KY Medicaid |
$5,554.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,611.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,666.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO M 9MM
|
Facility
|
IP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO M 9MM
|
Facility
|
OP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem Medicaid |
$5,554.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Humana KY Medicaid |
$5,554.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,611.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,666.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO S 11MM
|
Facility
|
IP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO S 11MM
|
Facility
|
OP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem Medicaid |
$5,554.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Humana KY Medicaid |
$5,554.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,611.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,666.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO S 8MM
|
Facility
|
OP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem Medicaid |
$5,554.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Humana KY Medicaid |
$5,554.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,611.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,666.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HEAD ENDO S 8MM
|
Facility
|
IP
|
$16,152.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,099.76 |
| Max. Negotiated Rate |
$15,505.92 |
| Rate for Payer: Aetna Commercial |
$12,437.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,598.56
|
| Rate for Payer: Cash Price |
$8,076.00
|
| Rate for Payer: Cigna Commercial |
$13,406.16
|
| Rate for Payer: First Health Commercial |
$15,344.40
|
| Rate for Payer: Humana Commercial |
$13,729.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,244.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,920.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,845.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,099.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,007.12
|
| Rate for Payer: PHCS Commercial |
$15,505.92
|
| Rate for Payer: United Healthcare All Payer |
$14,213.76
|
|
|
RADIAL HED CONSTRUCT 20MM*10MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*10MM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*14MM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*14MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*16MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*16MM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*18MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 20MM*18MM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 22MM*10MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 22MM*10MM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 22MM*12MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 22MM*12MM
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
RADIAL HED CONSTRUCT 22MM*14MM
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
