|
RING CONT RECN TRL 64ID 68OD L
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 64ID 68OD L
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 64ID 68OD R
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 64ID 68OD R
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 70ID 74OD L
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 70ID 74OD L
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 70ID 74OD R
|
Facility
|
OP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem Medicaid |
$1,095.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Humana KY Medicaid |
$1,095.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING CONT RECN TRL 70ID 74OD R
|
Facility
|
IP
|
$3,184.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.39 |
| Max. Negotiated Rate |
$3,057.24 |
| Rate for Payer: Aetna Commercial |
$2,452.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.00
|
| Rate for Payer: Cash Price |
$1,592.31
|
| Rate for Payer: Cigna Commercial |
$2,643.23
|
| Rate for Payer: First Health Commercial |
$3,025.39
|
| Rate for Payer: Humana Commercial |
$2,706.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,611.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,350.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,802.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,547.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,770.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,197.39
|
| Rate for Payer: PHCS Commercial |
$3,057.24
|
| Rate for Payer: United Healthcare All Payer |
$2,802.47
|
|
|
RING LOC BI-POLAR CUP 28/42
|
Facility
|
OP
|
$7,084.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.30 |
| Max. Negotiated Rate |
$6,800.98 |
| Rate for Payer: Aetna Commercial |
$5,454.95
|
| Rate for Payer: Anthem Medicaid |
$2,436.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.79
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Cigna Commercial |
$5,880.01
|
| Rate for Payer: First Health Commercial |
$6,730.13
|
| Rate for Payer: Humana Commercial |
$6,021.70
|
| Rate for Payer: Humana KY Medicaid |
$2,436.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.20
|
| Rate for Payer: PHCS Commercial |
$6,800.98
|
| Rate for Payer: United Healthcare All Payer |
$6,234.23
|
|
|
RING LOC BI-POLAR CUP 28/42
|
Facility
|
IP
|
$7,084.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.30 |
| Max. Negotiated Rate |
$6,800.98 |
| Rate for Payer: Aetna Commercial |
$5,454.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.79
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Cigna Commercial |
$5,880.01
|
| Rate for Payer: First Health Commercial |
$6,730.13
|
| Rate for Payer: Humana Commercial |
$6,021.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.20
|
| Rate for Payer: PHCS Commercial |
$6,800.98
|
| Rate for Payer: United Healthcare All Payer |
$6,234.23
|
|
|
RING LOC BI-POLAR CUP 28/44
|
Facility
|
IP
|
$7,675.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.70 |
| Max. Negotiated Rate |
$7,368.62 |
| Rate for Payer: Aetna Commercial |
$5,910.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,987.01
|
| Rate for Payer: Cash Price |
$3,837.82
|
| Rate for Payer: Cigna Commercial |
$6,370.79
|
| Rate for Payer: First Health Commercial |
$7,291.87
|
| Rate for Payer: Humana Commercial |
$6,524.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,294.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,140.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,677.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,296.20
|
| Rate for Payer: PHCS Commercial |
$7,368.62
|
| Rate for Payer: United Healthcare All Payer |
$6,754.57
|
|
|
RING LOC BI-POLAR CUP 28/44
|
Facility
|
OP
|
$7,675.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.70 |
| Max. Negotiated Rate |
$7,368.62 |
| Rate for Payer: Aetna Commercial |
$5,910.25
|
| Rate for Payer: Anthem Medicaid |
$2,639.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,987.01
|
| Rate for Payer: Cash Price |
$3,837.82
|
| Rate for Payer: Cigna Commercial |
$6,370.79
|
| Rate for Payer: First Health Commercial |
$7,291.87
|
| Rate for Payer: Humana Commercial |
$6,524.30
|
| Rate for Payer: Humana KY Medicaid |
$2,639.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,294.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,140.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,677.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,296.20
|
| Rate for Payer: PHCS Commercial |
$7,368.62
|
| Rate for Payer: United Healthcare All Payer |
$6,754.57
|
|
|
RING LOC BI-POLAR CUP 28/45
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
RING LOC BI-POLAR CUP 28/45
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
RING LOC BI-POLAR CUP 28/46
|
Facility
|
OP
|
$7,493.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.95 |
| Max. Negotiated Rate |
$7,193.42 |
| Rate for Payer: Aetna Commercial |
$5,769.73
|
| Rate for Payer: Anthem Medicaid |
$2,576.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.66
|
| Rate for Payer: Cash Price |
$3,746.57
|
| Rate for Payer: Cigna Commercial |
$6,219.31
|
| Rate for Payer: First Health Commercial |
$7,118.49
|
| Rate for Payer: Humana Commercial |
$6,369.18
|
| Rate for Payer: Humana KY Medicaid |
$2,576.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,994.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,519.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,170.27
|
| Rate for Payer: PHCS Commercial |
$7,193.42
|
| Rate for Payer: United Healthcare All Payer |
$6,593.97
|
|
|
RING LOC BI-POLAR CUP 28/46
|
Facility
|
IP
|
$7,493.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.95 |
| Max. Negotiated Rate |
$7,193.42 |
| Rate for Payer: Aetna Commercial |
$5,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.66
|
| Rate for Payer: Cash Price |
$3,746.57
|
| Rate for Payer: Cigna Commercial |
$6,219.31
|
| Rate for Payer: First Health Commercial |
$7,118.49
|
| Rate for Payer: Humana Commercial |
$6,369.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,994.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,519.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,170.27
|
| Rate for Payer: PHCS Commercial |
$7,193.42
|
| Rate for Payer: United Healthcare All Payer |
$6,593.97
|
|
|
RING LOC BI-POLAR CUP 28/49
|
Facility
|
IP
|
$7,493.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.95 |
| Max. Negotiated Rate |
$7,193.42 |
| Rate for Payer: Aetna Commercial |
$5,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.66
|
| Rate for Payer: Cash Price |
$3,746.57
|
| Rate for Payer: Cigna Commercial |
$6,219.31
|
| Rate for Payer: First Health Commercial |
$7,118.49
|
| Rate for Payer: Humana Commercial |
$6,369.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,994.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,519.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,170.27
|
| Rate for Payer: PHCS Commercial |
$7,193.42
|
| Rate for Payer: United Healthcare All Payer |
$6,593.97
|
|
|
RING LOC BI-POLAR CUP 28/49
|
Facility
|
OP
|
$7,493.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.95 |
| Max. Negotiated Rate |
$7,193.42 |
| Rate for Payer: Aetna Commercial |
$5,769.73
|
| Rate for Payer: Anthem Medicaid |
$2,576.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.66
|
| Rate for Payer: Cash Price |
$3,746.57
|
| Rate for Payer: Cigna Commercial |
$6,219.31
|
| Rate for Payer: First Health Commercial |
$7,118.49
|
| Rate for Payer: Humana Commercial |
$6,369.18
|
| Rate for Payer: Humana KY Medicaid |
$2,576.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,994.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,519.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,170.27
|
| Rate for Payer: PHCS Commercial |
$7,193.42
|
| Rate for Payer: United Healthcare All Payer |
$6,593.97
|
|
|
RING LOC BI-POLAR CUP 28/50
|
Facility
|
OP
|
$7,084.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.30 |
| Max. Negotiated Rate |
$6,800.98 |
| Rate for Payer: Aetna Commercial |
$5,454.95
|
| Rate for Payer: Anthem Medicaid |
$2,436.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.79
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Cigna Commercial |
$5,880.01
|
| Rate for Payer: First Health Commercial |
$6,730.13
|
| Rate for Payer: Humana Commercial |
$6,021.70
|
| Rate for Payer: Humana KY Medicaid |
$2,436.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.20
|
| Rate for Payer: PHCS Commercial |
$6,800.98
|
| Rate for Payer: United Healthcare All Payer |
$6,234.23
|
|
|
RING LOC BI-POLAR CUP 28/50
|
Facility
|
IP
|
$7,084.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.30 |
| Max. Negotiated Rate |
$6,800.98 |
| Rate for Payer: Aetna Commercial |
$5,454.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.79
|
| Rate for Payer: Cash Price |
$3,542.18
|
| Rate for Payer: Cigna Commercial |
$5,880.01
|
| Rate for Payer: First Health Commercial |
$6,730.13
|
| Rate for Payer: Humana Commercial |
$6,021.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.20
|
| Rate for Payer: PHCS Commercial |
$6,800.98
|
| Rate for Payer: United Healthcare All Payer |
$6,234.23
|
|
|
RING LOC BI-POLAR CUP 28/51
|
Facility
|
OP
|
$7,493.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.95 |
| Max. Negotiated Rate |
$7,193.42 |
| Rate for Payer: Aetna Commercial |
$5,769.73
|
| Rate for Payer: Anthem Medicaid |
$2,576.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.66
|
| Rate for Payer: Cash Price |
$3,746.57
|
| Rate for Payer: Cigna Commercial |
$6,219.31
|
| Rate for Payer: First Health Commercial |
$7,118.49
|
| Rate for Payer: Humana Commercial |
$6,369.18
|
| Rate for Payer: Humana KY Medicaid |
$2,576.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,994.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,519.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,170.27
|
| Rate for Payer: PHCS Commercial |
$7,193.42
|
| Rate for Payer: United Healthcare All Payer |
$6,593.97
|
|
|
RING LOC BI-POLAR CUP 28/51
|
Facility
|
IP
|
$7,493.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.95 |
| Max. Negotiated Rate |
$7,193.42 |
| Rate for Payer: Aetna Commercial |
$5,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.66
|
| Rate for Payer: Cash Price |
$3,746.57
|
| Rate for Payer: Cigna Commercial |
$6,219.31
|
| Rate for Payer: First Health Commercial |
$7,118.49
|
| Rate for Payer: Humana Commercial |
$6,369.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,994.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,519.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,170.27
|
| Rate for Payer: PHCS Commercial |
$7,193.42
|
| Rate for Payer: United Healthcare All Payer |
$6,593.97
|
|
|
RING LOC BI-POLAR CUP 28/52
|
Facility
|
OP
|
$7,675.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.70 |
| Max. Negotiated Rate |
$7,368.62 |
| Rate for Payer: Aetna Commercial |
$5,910.25
|
| Rate for Payer: Anthem Medicaid |
$2,639.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,987.01
|
| Rate for Payer: Cash Price |
$3,837.82
|
| Rate for Payer: Cigna Commercial |
$6,370.79
|
| Rate for Payer: First Health Commercial |
$7,291.87
|
| Rate for Payer: Humana Commercial |
$6,524.30
|
| Rate for Payer: Humana KY Medicaid |
$2,639.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,294.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,140.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,677.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,296.20
|
| Rate for Payer: PHCS Commercial |
$7,368.62
|
| Rate for Payer: United Healthcare All Payer |
$6,754.57
|
|
|
RING LOC BI-POLAR CUP 28/52
|
Facility
|
IP
|
$7,675.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.70 |
| Max. Negotiated Rate |
$7,368.62 |
| Rate for Payer: Aetna Commercial |
$5,910.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,987.01
|
| Rate for Payer: Cash Price |
$3,837.82
|
| Rate for Payer: Cigna Commercial |
$6,370.79
|
| Rate for Payer: First Health Commercial |
$7,291.87
|
| Rate for Payer: Humana Commercial |
$6,524.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,294.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,140.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,677.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,296.20
|
| Rate for Payer: PHCS Commercial |
$7,368.62
|
| Rate for Payer: United Healthcare All Payer |
$6,754.57
|
|
|
RINGLOC REPLCMNT RING SZ 22
|
Facility
|
IP
|
$2,038.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.62 |
| Max. Negotiated Rate |
$1,957.17 |
| Rate for Payer: Aetna Commercial |
$1,569.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.20
|
| Rate for Payer: Cash Price |
$1,019.36
|
| Rate for Payer: Cigna Commercial |
$1,692.14
|
| Rate for Payer: First Health Commercial |
$1,936.78
|
| Rate for Payer: Humana Commercial |
$1,732.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,406.72
|
| Rate for Payer: PHCS Commercial |
$1,957.17
|
| Rate for Payer: United Healthcare All Payer |
$1,794.07
|
|
