|
ROD HUMERAL POLARUS 8*240MM
|
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
|
|
|
ROD HUMERAL POLARUS 8*240MM
|
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*260MM
|
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*260MM
|
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*280MM
|
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*280MM
|
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 RADIUS LT 3.0MM*190MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.0MM*190MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.0MM*210MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.0MM*210MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.0MM*230MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.0MM*230MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.6MM*190MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.6MM*190MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.6MM*210MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.6MM*210MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.6MM*230MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS LT 3.6MM*230MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.0MM*19OMM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.0MM*19OMM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.0MM*210MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.0MM*210MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.0MM*230MM
|
Facility
|
IP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.0MM*230MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
|
ROD RADIUS RT 3.6MM*190MM
|
Facility
|
OP
|
$5,118.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.36 |
| Max. Negotiated Rate |
$4,913.40 |
| Rate for Payer: Aetna Commercial |
$3,940.95
|
| Rate for Payer: Anthem Medicaid |
$1,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,992.13
|
| Rate for Payer: Cash Price |
$2,559.06
|
| Rate for Payer: Cigna Commercial |
$4,248.04
|
| Rate for Payer: First Health Commercial |
$4,862.21
|
| Rate for Payer: Humana Commercial |
$4,350.40
|
| Rate for Payer: Humana KY Medicaid |
$1,760.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,196.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,777.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,535.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,795.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,503.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,838.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,586.62
|
| Rate for Payer: PHCS Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Payer |
$4,503.95
|
|
