|
ROD RADIUS LT 3.6MM*230MM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS LT 3.6MM*230MM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.0MM*19OMM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.0MM*19OMM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.0MM*210MM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.0MM*210MM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.0MM*230MM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.0MM*230MM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.6MM*190MM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.6MM*190MM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.6MM*210MM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.6MM*210MM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.6MM*230MM
|
Facility
|
IP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD RADIUS RT 3.6MM*230MM
|
Facility
|
OP
|
$5,126.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$4,921.50 |
| Rate for Payer: Aetna Commercial |
$3,947.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,998.72
|
| Rate for Payer: Cash Price |
$2,563.28
|
| Rate for Payer: Cigna Commercial |
$4,255.04
|
| Rate for Payer: First Health Commercial |
$4,870.23
|
| Rate for Payer: Humana Commercial |
$4,357.58
|
| Rate for Payer: Humana KY Medicaid |
$1,763.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,780.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,203.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,783.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,798.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,511.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,844.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,101.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,460.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,537.33
|
| Rate for Payer: PHCS Commercial |
$4,921.50
|
| Rate for Payer: United Healthcare All Payer |
$4,511.37
|
|
|
ROD SHORT QC
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
ROD SHORT QC
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
ROD THREADED 30MM
|
Facility
|
OP
|
$559.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.82 |
| Max. Negotiated Rate |
$537.02 |
| Rate for Payer: Aetna Commercial |
$430.74
|
| Rate for Payer: Anthem Medicaid |
$192.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.33
|
| Rate for Payer: Cash Price |
$279.70
|
| Rate for Payer: Cigna Commercial |
$464.30
|
| Rate for Payer: First Health Commercial |
$531.43
|
| Rate for Payer: Humana Commercial |
$475.49
|
| Rate for Payer: Humana KY Medicaid |
$192.38
|
| Rate for Payer: Kentucky WC Medicaid |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.27
|
| Rate for Payer: Ohio Health Group HMO |
$419.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.99
|
| Rate for Payer: PHCS Commercial |
$537.02
|
| Rate for Payer: United Healthcare All Payer |
$492.27
|
|
|
ROD THREADED 30MM
|
Facility
|
IP
|
$559.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.82 |
| Max. Negotiated Rate |
$537.02 |
| Rate for Payer: Aetna Commercial |
$430.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.33
|
| Rate for Payer: Cash Price |
$279.70
|
| Rate for Payer: Cigna Commercial |
$464.30
|
| Rate for Payer: First Health Commercial |
$531.43
|
| Rate for Payer: Humana Commercial |
$475.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.27
|
| Rate for Payer: Ohio Health Group HMO |
$419.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$447.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.99
|
| Rate for Payer: PHCS Commercial |
$537.02
|
| Rate for Payer: United Healthcare All Payer |
$492.27
|
|
|
ROD THREADED 350MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ROD THREADED 350MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ROD THREADED SLOTTED 40MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ROD THREADED SLOTTED 40MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ROD THREADED SLOTTED 60MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ROD THREADED SLOTTED 60MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
ROD TO ROD COUPLING 8/8MM
|
Facility
|
OP
|
$4,445.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.50 |
| Max. Negotiated Rate |
$4,267.20 |
| Rate for Payer: Aetna Commercial |
$3,422.65
|
| Rate for Payer: Anthem Medicaid |
$1,528.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.10
|
| Rate for Payer: Cash Price |
$2,222.50
|
| Rate for Payer: Cigna Commercial |
$3,689.35
|
| Rate for Payer: First Health Commercial |
$4,222.75
|
| Rate for Payer: Humana Commercial |
$3,778.25
|
| Rate for Payer: Humana KY Medicaid |
$1,528.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,544.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,559.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,556.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,867.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.05
|
| Rate for Payer: PHCS Commercial |
$4,267.20
|
| Rate for Payer: United Healthcare All Payer |
$3,911.60
|
|
