|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
IP
|
$74.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna Commercial |
$57.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.26
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cigna Commercial |
$61.99
|
| Rate for Payer: First Health Commercial |
$70.96
|
| Rate for Payer: Humana Commercial |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.73
|
| Rate for Payer: Ohio Health Group HMO |
$56.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.15
|
| Rate for Payer: PHCS Commercial |
$71.70
|
| Rate for Payer: United Healthcare All Payer |
$65.73
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25001948
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.99
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
OP
|
$74.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna Commercial |
$57.51
|
| Rate for Payer: Anthem Medicaid |
$25.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.26
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cigna Commercial |
$61.99
|
| Rate for Payer: First Health Commercial |
$70.96
|
| Rate for Payer: Humana Commercial |
$63.49
|
| Rate for Payer: Humana KY Medicaid |
$25.69
|
| Rate for Payer: Kentucky WC Medicaid |
$25.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.73
|
| Rate for Payer: Ohio Health Group HMO |
$56.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.15
|
| Rate for Payer: PHCS Commercial |
$71.70
|
| Rate for Payer: United Healthcare All Payer |
$65.73
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Facility
|
OP
|
$74.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
636T0022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna Commercial |
$57.51
|
| Rate for Payer: Anthem Medicaid |
$25.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.26
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cigna Commercial |
$61.99
|
| Rate for Payer: First Health Commercial |
$70.96
|
| Rate for Payer: Humana Commercial |
$63.49
|
| Rate for Payer: Humana KY Medicaid |
$25.69
|
| Rate for Payer: Kentucky WC Medicaid |
$25.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.73
|
| Rate for Payer: Ohio Health Group HMO |
$56.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.15
|
| Rate for Payer: PHCS Commercial |
$71.70
|
| Rate for Payer: United Healthcare All Payer |
$65.73
|
|
|
ROCEPHIN(CETRIAXON)250MG VL IM
|
Professional
|
Both
|
$74.69
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$74.69 |
| Rate for Payer: Aetna Commercial |
$0.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.69
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Healthspan PPO |
$2.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.77
|
| Rate for Payer: Multiplan PHCS |
$44.81
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.28
|
| Rate for Payer: UHCCP Medicaid |
$26.14
|
|
|
ROCEPHIN(PEDIATRIC IV)1GM/10ML
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25003808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Humana KY Medicaid |
$26.66
|
| Rate for Payer: Kentucky WC Medicaid |
$26.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.03
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROCEPHIN(PEDIATRIC IV)1GM/10ML
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
25003808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$74.42 |
| Rate for Payer: Aetna Commercial |
$59.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.47
|
| Rate for Payer: Cash Price |
$38.76
|
| Rate for Payer: Cigna Commercial |
$64.34
|
| Rate for Payer: First Health Commercial |
$73.64
|
| Rate for Payer: Humana Commercial |
$65.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.22
|
| Rate for Payer: Ohio Health Group HMO |
$58.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.03
|
| Rate for Payer: PHCS Commercial |
$74.42
|
| Rate for Payer: United Healthcare All Payer |
$68.22
|
|
|
ROD BALL TIP GUIDE 3.0*1000MM
|
Facility
|
OP
|
$2,057.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.46 |
| Max. Negotiated Rate |
$1,975.06 |
| Rate for Payer: Aetna Commercial |
$1,584.16
|
| Rate for Payer: Anthem Medicaid |
$707.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.73
|
| Rate for Payer: Cash Price |
$1,028.67
|
| Rate for Payer: Cigna Commercial |
$1,707.60
|
| Rate for Payer: First Health Commercial |
$1,954.48
|
| Rate for Payer: Humana Commercial |
$1,748.75
|
| Rate for Payer: Humana KY Medicaid |
$707.52
|
| Rate for Payer: Kentucky WC Medicaid |
$714.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.78
|
| Rate for Payer: PHCS Commercial |
$1,975.06
|
| Rate for Payer: United Healthcare All Payer |
$1,810.47
|
|
|
ROD BALL TIP GUIDE 3.0*1000MM
|
Facility
|
IP
|
$2,057.35
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.46 |
| Max. Negotiated Rate |
$1,975.06 |
| Rate for Payer: Aetna Commercial |
$1,584.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.73
|
| Rate for Payer: Cash Price |
$1,028.67
|
| Rate for Payer: Cigna Commercial |
$1,707.60
|
| Rate for Payer: First Health Commercial |
$1,954.48
|
| Rate for Payer: Humana Commercial |
$1,748.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.78
|
| Rate for Payer: PHCS Commercial |
$1,975.06
|
| Rate for Payer: United Healthcare All Payer |
$1,810.47
|
|
|
ROD FIBULA 3.0*110MM
|
Facility
|
OP
|
$7,041.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$6,759.65 |
| Rate for Payer: Aetna Commercial |
$5,421.80
|
| Rate for Payer: Anthem Medicaid |
$2,421.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.21
|
| Rate for Payer: Cash Price |
$3,520.65
|
| Rate for Payer: Cigna Commercial |
$5,844.28
|
| Rate for Payer: First Health Commercial |
$6,689.24
|
| Rate for Payer: Humana Commercial |
$5,985.10
|
| Rate for Payer: Humana KY Medicaid |
$2,421.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,280.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.80
|
| Rate for Payer: PHCS Commercial |
$6,759.65
|
| Rate for Payer: United Healthcare All Payer |
$6,196.34
|
|
|
ROD FIBULA 3.0*110MM
|
Facility
|
IP
|
$7,041.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$6,759.65 |
| Rate for Payer: Aetna Commercial |
$5,421.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.21
|
| Rate for Payer: Cash Price |
$3,520.65
|
| Rate for Payer: Cigna Commercial |
$5,844.28
|
| Rate for Payer: First Health Commercial |
$6,689.24
|
| Rate for Payer: Humana Commercial |
$5,985.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,280.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.80
|
| Rate for Payer: PHCS Commercial |
$6,759.65
|
| Rate for Payer: United Healthcare All Payer |
$6,196.34
|
|
|
ROD FIBULA 3.0*145MM
|
Facility
|
OP
|
$7,041.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$6,759.65 |
| Rate for Payer: Aetna Commercial |
$5,421.80
|
| Rate for Payer: Anthem Medicaid |
$2,421.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.21
|
| Rate for Payer: Cash Price |
$3,520.65
|
| Rate for Payer: Cigna Commercial |
$5,844.28
|
| Rate for Payer: First Health Commercial |
$6,689.24
|
| Rate for Payer: Humana Commercial |
$5,985.10
|
| Rate for Payer: Humana KY Medicaid |
$2,421.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,280.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.80
|
| Rate for Payer: PHCS Commercial |
$6,759.65
|
| Rate for Payer: United Healthcare All Payer |
$6,196.34
|
|
|
ROD FIBULA 3.0*145MM
|
Facility
|
IP
|
$7,041.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$6,759.65 |
| Rate for Payer: Aetna Commercial |
$5,421.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.21
|
| Rate for Payer: Cash Price |
$3,520.65
|
| Rate for Payer: Cigna Commercial |
$5,844.28
|
| Rate for Payer: First Health Commercial |
$6,689.24
|
| Rate for Payer: Humana Commercial |
$5,985.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,280.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.80
|
| Rate for Payer: PHCS Commercial |
$6,759.65
|
| Rate for Payer: United Healthcare All Payer |
$6,196.34
|
|
|
ROD FIBULA 3.0*180MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
ROD FIBULA 3.0*180MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
ROD FIBULA 3.6*110MM
|
Facility
|
IP
|
$7,041.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$6,759.65 |
| Rate for Payer: Aetna Commercial |
$5,421.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.21
|
| Rate for Payer: Cash Price |
$3,520.65
|
| Rate for Payer: Cigna Commercial |
$5,844.28
|
| Rate for Payer: First Health Commercial |
$6,689.24
|
| Rate for Payer: Humana Commercial |
$5,985.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,280.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.80
|
| Rate for Payer: PHCS Commercial |
$6,759.65
|
| Rate for Payer: United Healthcare All Payer |
$6,196.34
|
|
|
ROD FIBULA 3.6*110MM
|
Facility
|
OP
|
$7,041.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$6,759.65 |
| Rate for Payer: Aetna Commercial |
$5,421.80
|
| Rate for Payer: Anthem Medicaid |
$2,421.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.21
|
| Rate for Payer: Cash Price |
$3,520.65
|
| Rate for Payer: Cigna Commercial |
$5,844.28
|
| Rate for Payer: First Health Commercial |
$6,689.24
|
| Rate for Payer: Humana Commercial |
$5,985.10
|
| Rate for Payer: Humana KY Medicaid |
$2,421.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,280.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.80
|
| Rate for Payer: PHCS Commercial |
$6,759.65
|
| Rate for Payer: United Healthcare All Payer |
$6,196.34
|
|
|
ROD FIBULA 3.6*145MM
|
Facility
|
OP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem Medicaid |
$2,293.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Humana KY Medicaid |
$2,293.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
ROD FIBULA 3.6*145MM
|
Facility
|
IP
|
$6,669.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$866.97 |
| Max. Negotiated Rate |
$6,402.24 |
| Rate for Payer: Aetna Commercial |
$5,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
| Rate for Payer: Cash Price |
$3,334.50
|
| Rate for Payer: Cigna Commercial |
$5,535.27
|
| Rate for Payer: First Health Commercial |
$6,335.55
|
| Rate for Payer: Humana Commercial |
$5,668.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
| Rate for Payer: PHCS Commercial |
$6,402.24
|
| Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
|
ROD HUMERAL POLARUS 11*150MM
|
Facility
|
OP
|
$11,001.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,430.20 |
| Max. Negotiated Rate |
$10,561.44 |
| Rate for Payer: Aetna Commercial |
$8,471.16
|
| Rate for Payer: Anthem Medicaid |
$3,783.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,581.17
|
| Rate for Payer: Cash Price |
$5,500.75
|
| Rate for Payer: Cigna Commercial |
$9,131.24
|
| Rate for Payer: First Health Commercial |
$10,451.42
|
| Rate for Payer: Humana Commercial |
$9,351.28
|
| Rate for Payer: Humana KY Medicaid |
$3,783.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,821.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,021.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,119.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,300.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,859.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,681.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,251.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,200.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,430.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,410.46
|
| Rate for Payer: PHCS Commercial |
$10,561.44
|
| Rate for Payer: United Healthcare All Payer |
$9,681.32
|
|
|
ROD HUMERAL POLARUS 11*150MM
|
Facility
|
IP
|
$11,001.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,430.20 |
| Max. Negotiated Rate |
$10,561.44 |
| Rate for Payer: Aetna Commercial |
$8,471.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,581.17
|
| Rate for Payer: Cash Price |
$5,500.75
|
| Rate for Payer: Cigna Commercial |
$9,131.24
|
| Rate for Payer: First Health Commercial |
$10,451.42
|
| Rate for Payer: Humana Commercial |
$9,351.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,021.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,119.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,300.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,681.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,251.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,200.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,430.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,410.46
|
| Rate for Payer: PHCS Commercial |
$10,561.44
|
| Rate for Payer: United Healthcare All Payer |
$9,681.32
|
|
|
ROD HUMERAL POLARUS 8*200MM
|
Facility
|
IP
|
$9,143.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.68 |
| Max. Negotiated Rate |
$8,777.95 |
| Rate for Payer: Aetna Commercial |
$7,040.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,132.09
|
| Rate for Payer: Cash Price |
$4,571.85
|
| Rate for Payer: Cigna Commercial |
$7,589.27
|
| Rate for Payer: First Health Commercial |
$8,686.52
|
| Rate for Payer: Humana Commercial |
$7,772.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,497.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,748.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,743.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,046.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,857.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,834.55
|
| Rate for Payer: PHCS Commercial |
$8,777.95
|
| Rate for Payer: United Healthcare All Payer |
$8,046.46
|
|
|
ROD HUMERAL POLARUS 8*200MM
|
Facility
|
OP
|
$9,143.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.68 |
| Max. Negotiated Rate |
$8,777.95 |
| Rate for Payer: Aetna Commercial |
$7,040.65
|
| Rate for Payer: Anthem Medicaid |
$3,144.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,132.09
|
| Rate for Payer: Cash Price |
$4,571.85
|
| Rate for Payer: Cigna Commercial |
$7,589.27
|
| Rate for Payer: First Health Commercial |
$8,686.52
|
| Rate for Payer: Humana Commercial |
$7,772.14
|
| Rate for Payer: Humana KY Medicaid |
$3,144.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3,176.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,497.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,748.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,743.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,207.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,046.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,857.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,834.55
|
| Rate for Payer: PHCS Commercial |
$8,777.95
|
| Rate for Payer: United Healthcare All Payer |
$8,046.46
|
|
|
ROD HUMERAL POLARUS 8*220MM
|
Facility
|
OP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem Medicaid |
$2,780.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Humana KY Medicaid |
$2,780.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,808.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,836.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
|
ROD HUMERAL POLARUS 8*220MM
|
Facility
|
IP
|
$8,085.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.08 |
| Max. Negotiated Rate |
$7,761.79 |
| Rate for Payer: Aetna Commercial |
$6,225.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,306.46
|
| Rate for Payer: Cash Price |
$4,042.60
|
| Rate for Payer: Cigna Commercial |
$6,710.72
|
| Rate for Payer: First Health Commercial |
$7,680.94
|
| Rate for Payer: Humana Commercial |
$6,872.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,629.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,966.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,425.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,114.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,063.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,506.41
|
| Rate for Payer: PHCS Commercial |
$7,761.79
|
| Rate for Payer: United Healthcare All Payer |
$7,114.98
|
|
