|
RINGLOC REPLCMNT RING SZ 22
|
Facility
|
OP
|
$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 Medicaid |
$701.12
|
| 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: Humana KY Medicaid |
$701.12
|
| Rate for Payer: Kentucky WC Medicaid |
$708.25
|
| 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: Molina Healthcare Medicaid |
$715.18
|
| 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
|
|
|
RINGLOC REPLCMNT RING SZ 23
|
Facility
|
OP
|
$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 Medicaid |
$701.12
|
| 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: Humana KY Medicaid |
$701.12
|
| Rate for Payer: Kentucky WC Medicaid |
$708.25
|
| 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: Molina Healthcare Medicaid |
$715.18
|
| 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
|
|
|
RINGLOC REPLCMNT RING SZ 23
|
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
|
|
|
RINGLOC REPLCMNT RING SZ 24
|
Facility
|
OP
|
$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 Medicaid |
$701.12
|
| 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: Humana KY Medicaid |
$701.12
|
| Rate for Payer: Kentucky WC Medicaid |
$708.25
|
| 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: Molina Healthcare Medicaid |
$715.18
|
| 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
|
|
|
RINGLOC REPLCMNT RING SZ 24
|
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
|
|
|
RINGLOC REPLCMNT RING SZ 25
|
Facility
|
OP
|
$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 Medicaid |
$701.12
|
| 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: Humana KY Medicaid |
$701.12
|
| Rate for Payer: Kentucky WC Medicaid |
$708.25
|
| 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: Molina Healthcare Medicaid |
$715.18
|
| 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
|
|
|
RINGLOC REPLCMNT RING SZ 25
|
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
|
|
|
RINGLOC REPLCMNT RING SZ 26
|
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
|
|
|
RINGLOC REPLCMNT RING SZ 26
|
Facility
|
OP
|
$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 Medicaid |
$701.12
|
| 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: Humana KY Medicaid |
$701.12
|
| Rate for Payer: Kentucky WC Medicaid |
$708.25
|
| 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: Molina Healthcare Medicaid |
$715.18
|
| 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
|
|
|
RINGLOC REPLCMNT RING SZ 27
|
Facility
|
OP
|
$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 Medicaid |
$701.12
|
| 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: Humana KY Medicaid |
$701.12
|
| Rate for Payer: Kentucky WC Medicaid |
$708.25
|
| 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: Molina Healthcare Medicaid |
$715.18
|
| 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
|
|
|
RINGLOC REPLCMNT RING SZ 27
|
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
|
|
|
RING RINGLOC LOCKING SZ 20
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 20
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 21
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 21
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 22
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 22
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 23
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 23
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 24
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 24
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 25
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 25
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 26
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
RING RINGLOC LOCKING SZ 26
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
