|
RING LOC BI-POLAR CUP 28/42
|
Facility
|
IP
|
$6,884.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.97 |
| Max. Negotiated Rate |
$6,608.98 |
| Rate for Payer: Aetna Commercial |
$5,300.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.79
|
| Rate for Payer: Cash Price |
$3,442.18
|
| Rate for Payer: Cigna Commercial |
$5,714.01
|
| Rate for Payer: First Health Commercial |
$6,540.13
|
| Rate for Payer: Humana Commercial |
$5,851.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,645.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,058.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,163.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.15
|
| Rate for Payer: PHCS Commercial |
$6,608.98
|
| Rate for Payer: United Healthcare All Payer |
$6,058.23
|
|
|
RING LOC BI-POLAR CUP 28/44
|
Facility
|
IP
|
$7,475.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.83 |
| Max. Negotiated Rate |
$7,176.62 |
| Rate for Payer: Aetna Commercial |
$5,756.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,831.01
|
| Rate for Payer: Cash Price |
$3,737.82
|
| Rate for Payer: Cigna Commercial |
$6,204.79
|
| Rate for Payer: First Health Commercial |
$7,101.87
|
| Rate for Payer: Humana Commercial |
$6,354.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,130.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,517.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,578.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,606.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.45
|
| Rate for Payer: PHCS Commercial |
$7,176.62
|
| Rate for Payer: United Healthcare All Payer |
$6,578.57
|
|
|
RING LOC BI-POLAR CUP 28/44
|
Facility
|
OP
|
$7,475.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.83 |
| Max. Negotiated Rate |
$7,176.62 |
| Rate for Payer: Aetna Commercial |
$5,756.25
|
| Rate for Payer: Anthem Medicaid |
$2,570.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,831.01
|
| Rate for Payer: Cash Price |
$3,737.82
|
| Rate for Payer: Cigna Commercial |
$6,204.79
|
| Rate for Payer: First Health Commercial |
$7,101.87
|
| Rate for Payer: Humana Commercial |
$6,354.30
|
| Rate for Payer: Humana KY Medicaid |
$2,570.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,597.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,130.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,517.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,622.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,578.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,606.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.45
|
| Rate for Payer: PHCS Commercial |
$7,176.62
|
| Rate for Payer: United Healthcare All Payer |
$6,578.57
|
|
|
RING LOC BI-POLAR CUP 28/45
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
RING LOC BI-POLAR CUP 28/45
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
RING LOC BI-POLAR CUP 28/46
|
Facility
|
IP
|
$7,293.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.11 |
| Max. Negotiated Rate |
$7,001.42 |
| Rate for Payer: Aetna Commercial |
$5,615.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.66
|
| Rate for Payer: Cash Price |
$3,646.57
|
| Rate for Payer: Cigna Commercial |
$6,053.31
|
| Rate for Payer: First Health Commercial |
$6,928.49
|
| Rate for Payer: Humana Commercial |
$6,199.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.88
|
| Rate for Payer: PHCS Commercial |
$7,001.42
|
| Rate for Payer: United Healthcare All Payer |
$6,417.97
|
|
|
RING LOC BI-POLAR CUP 28/46
|
Facility
|
OP
|
$7,293.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.11 |
| Max. Negotiated Rate |
$7,001.42 |
| Rate for Payer: Aetna Commercial |
$5,615.73
|
| Rate for Payer: Anthem Medicaid |
$2,508.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.66
|
| Rate for Payer: Cash Price |
$3,646.57
|
| Rate for Payer: Cigna Commercial |
$6,053.31
|
| Rate for Payer: First Health Commercial |
$6,928.49
|
| Rate for Payer: Humana Commercial |
$6,199.18
|
| Rate for Payer: Humana KY Medicaid |
$2,508.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.88
|
| Rate for Payer: PHCS Commercial |
$7,001.42
|
| Rate for Payer: United Healthcare All Payer |
$6,417.97
|
|
|
RING LOC BI-POLAR CUP 28/49
|
Facility
|
OP
|
$7,293.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.11 |
| Max. Negotiated Rate |
$7,001.42 |
| Rate for Payer: Aetna Commercial |
$5,615.73
|
| Rate for Payer: Anthem Medicaid |
$2,508.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.66
|
| Rate for Payer: Cash Price |
$3,646.57
|
| Rate for Payer: Cigna Commercial |
$6,053.31
|
| Rate for Payer: First Health Commercial |
$6,928.49
|
| Rate for Payer: Humana Commercial |
$6,199.18
|
| Rate for Payer: Humana KY Medicaid |
$2,508.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.88
|
| Rate for Payer: PHCS Commercial |
$7,001.42
|
| Rate for Payer: United Healthcare All Payer |
$6,417.97
|
|
|
RING LOC BI-POLAR CUP 28/49
|
Facility
|
IP
|
$7,293.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.11 |
| Max. Negotiated Rate |
$7,001.42 |
| Rate for Payer: Aetna Commercial |
$5,615.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.66
|
| Rate for Payer: Cash Price |
$3,646.57
|
| Rate for Payer: Cigna Commercial |
$6,053.31
|
| Rate for Payer: First Health Commercial |
$6,928.49
|
| Rate for Payer: Humana Commercial |
$6,199.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.88
|
| Rate for Payer: PHCS Commercial |
$7,001.42
|
| Rate for Payer: United Healthcare All Payer |
$6,417.97
|
|
|
RING LOC BI-POLAR CUP 28/50
|
Facility
|
IP
|
$6,884.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.97 |
| Max. Negotiated Rate |
$6,608.98 |
| Rate for Payer: Aetna Commercial |
$5,300.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.79
|
| Rate for Payer: Cash Price |
$3,442.18
|
| Rate for Payer: Cigna Commercial |
$5,714.01
|
| Rate for Payer: First Health Commercial |
$6,540.13
|
| Rate for Payer: Humana Commercial |
$5,851.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,645.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,058.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,163.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.15
|
| Rate for Payer: PHCS Commercial |
$6,608.98
|
| Rate for Payer: United Healthcare All Payer |
$6,058.23
|
|
|
RING LOC BI-POLAR CUP 28/50
|
Facility
|
OP
|
$6,884.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.97 |
| Max. Negotiated Rate |
$6,608.98 |
| Rate for Payer: Aetna Commercial |
$5,300.95
|
| Rate for Payer: Anthem Medicaid |
$2,367.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.79
|
| Rate for Payer: Cash Price |
$3,442.18
|
| Rate for Payer: Cigna Commercial |
$5,714.01
|
| Rate for Payer: First Health Commercial |
$6,540.13
|
| Rate for Payer: Humana Commercial |
$5,851.70
|
| Rate for Payer: Humana KY Medicaid |
$2,367.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,391.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,645.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,058.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,163.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.15
|
| Rate for Payer: PHCS Commercial |
$6,608.98
|
| Rate for Payer: United Healthcare All Payer |
$6,058.23
|
|
|
RING LOC BI-POLAR CUP 28/51
|
Facility
|
IP
|
$7,293.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.11 |
| Max. Negotiated Rate |
$7,001.42 |
| Rate for Payer: Aetna Commercial |
$5,615.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.66
|
| Rate for Payer: Cash Price |
$3,646.57
|
| Rate for Payer: Cigna Commercial |
$6,053.31
|
| Rate for Payer: First Health Commercial |
$6,928.49
|
| Rate for Payer: Humana Commercial |
$6,199.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.88
|
| Rate for Payer: PHCS Commercial |
$7,001.42
|
| Rate for Payer: United Healthcare All Payer |
$6,417.97
|
|
|
RING LOC BI-POLAR CUP 28/51
|
Facility
|
OP
|
$7,293.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.11 |
| Max. Negotiated Rate |
$7,001.42 |
| Rate for Payer: Aetna Commercial |
$5,615.73
|
| Rate for Payer: Anthem Medicaid |
$2,508.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,688.66
|
| Rate for Payer: Cash Price |
$3,646.57
|
| Rate for Payer: Cigna Commercial |
$6,053.31
|
| Rate for Payer: First Health Commercial |
$6,928.49
|
| Rate for Payer: Humana Commercial |
$6,199.18
|
| Rate for Payer: Humana KY Medicaid |
$2,508.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,533.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,980.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,417.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,469.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$948.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.88
|
| Rate for Payer: PHCS Commercial |
$7,001.42
|
| Rate for Payer: United Healthcare All Payer |
$6,417.97
|
|
|
RING LOC BI-POLAR CUP 28/52
|
Facility
|
IP
|
$7,475.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.83 |
| Max. Negotiated Rate |
$7,176.62 |
| Rate for Payer: Aetna Commercial |
$5,756.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,831.01
|
| Rate for Payer: Cash Price |
$3,737.82
|
| Rate for Payer: Cigna Commercial |
$6,204.79
|
| Rate for Payer: First Health Commercial |
$7,101.87
|
| Rate for Payer: Humana Commercial |
$6,354.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,130.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,517.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,578.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,606.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.45
|
| Rate for Payer: PHCS Commercial |
$7,176.62
|
| Rate for Payer: United Healthcare All Payer |
$6,578.57
|
|
|
RING LOC BI-POLAR CUP 28/52
|
Facility
|
OP
|
$7,475.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.83 |
| Max. Negotiated Rate |
$7,176.62 |
| Rate for Payer: Aetna Commercial |
$5,756.25
|
| Rate for Payer: Anthem Medicaid |
$2,570.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,831.01
|
| Rate for Payer: Cash Price |
$3,737.82
|
| Rate for Payer: Cigna Commercial |
$6,204.79
|
| Rate for Payer: First Health Commercial |
$7,101.87
|
| Rate for Payer: Humana Commercial |
$6,354.30
|
| Rate for Payer: Humana KY Medicaid |
$2,570.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,597.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,130.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,517.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,622.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,578.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,606.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.45
|
| Rate for Payer: PHCS Commercial |
$7,176.62
|
| Rate for Payer: United Healthcare All Payer |
$6,578.57
|
|
|
RINGLOC REPLCMNT RING SZ 22
|
Facility
|
OP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem Medicaid |
$698.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Humana KY Medicaid |
$698.25
|
| Rate for Payer: Kentucky WC Medicaid |
$705.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 22
|
Facility
|
IP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 23
|
Facility
|
IP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 23
|
Facility
|
OP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem Medicaid |
$698.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Humana KY Medicaid |
$698.25
|
| Rate for Payer: Kentucky WC Medicaid |
$705.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 24
|
Facility
|
IP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 24
|
Facility
|
OP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem Medicaid |
$698.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Humana KY Medicaid |
$698.25
|
| Rate for Payer: Kentucky WC Medicaid |
$705.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 25
|
Facility
|
OP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem Medicaid |
$698.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Humana KY Medicaid |
$698.25
|
| Rate for Payer: Kentucky WC Medicaid |
$705.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 25
|
Facility
|
IP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 26
|
Facility
|
OP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem Medicaid |
$698.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Humana KY Medicaid |
$698.25
|
| Rate for Payer: Kentucky WC Medicaid |
$705.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
|
RINGLOC REPLCMNT RING SZ 26
|
Facility
|
IP
|
$2,030.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.95 |
| Max. Negotiated Rate |
$1,949.18 |
| Rate for Payer: Aetna Commercial |
$1,563.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.71
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna Commercial |
$1,685.23
|
| Rate for Payer: First Health Commercial |
$1,928.88
|
| Rate for Payer: Humana Commercial |
$1,725.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.42
|
| Rate for Payer: PHCS Commercial |
$1,949.18
|
| Rate for Payer: United Healthcare All Payer |
$1,786.75
|
|
