|
SROM NRH PLAT ASSY SM 21MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 21MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 26MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 26MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 31MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 31MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 12MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 12MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 16MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 16MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 21MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 21MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 26MM
|
Facility
|
IP
|
$15,414.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.82 |
| Max. Negotiated Rate |
$14,797.44 |
| Rate for Payer: Aetna Commercial |
$11,868.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,022.92
|
| Rate for Payer: Cash Price |
$7,707.00
|
| Rate for Payer: Cigna Commercial |
$12,793.62
|
| Rate for Payer: First Health Commercial |
$14,643.30
|
| Rate for Payer: Humana Commercial |
$13,101.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,639.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,375.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,624.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,564.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,560.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,082.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,003.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,778.34
|
| Rate for Payer: PHCS Commercial |
$14,797.44
|
| Rate for Payer: United Healthcare All Payer |
$13,564.32
|
|
|
SROM NRH PLAT ASSY XS 26MM
|
Facility
|
OP
|
$15,414.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,003.82 |
| Max. Negotiated Rate |
$14,797.44 |
| Rate for Payer: Aetna Commercial |
$11,868.78
|
| Rate for Payer: Anthem Medicaid |
$5,300.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,022.92
|
| Rate for Payer: Cash Price |
$7,707.00
|
| Rate for Payer: Cigna Commercial |
$12,793.62
|
| Rate for Payer: First Health Commercial |
$14,643.30
|
| Rate for Payer: Humana Commercial |
$13,101.90
|
| Rate for Payer: Humana KY Medicaid |
$5,300.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,354.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,639.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,375.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,624.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,407.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,564.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,560.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,082.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,003.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,778.34
|
| Rate for Payer: PHCS Commercial |
$14,797.44
|
| Rate for Payer: United Healthcare All Payer |
$13,564.32
|
|
|
SROM NRH PLAT ASSY XS 31MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY XS 31MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH REPL HINGE BRG QTY 2
|
Facility
|
IP
|
$2,018.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.41 |
| Max. Negotiated Rate |
$1,937.80 |
| Rate for Payer: Aetna Commercial |
$1,554.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.46
|
| Rate for Payer: Cash Price |
$1,009.27
|
| Rate for Payer: Cigna Commercial |
$1,675.39
|
| Rate for Payer: First Health Commercial |
$1,917.61
|
| Rate for Payer: Humana Commercial |
$1,715.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.75
|
| Rate for Payer: PHCS Commercial |
$1,937.80
|
| Rate for Payer: United Healthcare All Payer |
$1,776.32
|
|
|
SROM NRH REPL HINGE BRG QTY 2
|
Facility
|
OP
|
$2,018.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.41 |
| Max. Negotiated Rate |
$1,937.80 |
| Rate for Payer: Aetna Commercial |
$1,554.28
|
| Rate for Payer: Anthem Medicaid |
$694.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.46
|
| Rate for Payer: Cash Price |
$1,009.27
|
| Rate for Payer: Cigna Commercial |
$1,675.39
|
| Rate for Payer: First Health Commercial |
$1,917.61
|
| Rate for Payer: Humana Commercial |
$1,715.76
|
| Rate for Payer: Humana KY Medicaid |
$694.18
|
| Rate for Payer: Kentucky WC Medicaid |
$701.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.75
|
| Rate for Payer: PHCS Commercial |
$1,937.80
|
| Rate for Payer: United Healthcare All Payer |
$1,776.32
|
|
|
SROM NRH REPL HINGE PIN MED
|
Facility
|
IP
|
$3,320.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.70 |
| Max. Negotiated Rate |
$3,187.94 |
| Rate for Payer: Aetna Commercial |
$2,556.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.20
|
| Rate for Payer: Cash Price |
$1,660.38
|
| Rate for Payer: Cigna Commercial |
$2,756.24
|
| Rate for Payer: First Health Commercial |
$3,154.73
|
| Rate for Payer: Humana Commercial |
$2,822.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.44
|
| Rate for Payer: PHCS Commercial |
$3,187.94
|
| Rate for Payer: United Healthcare All Payer |
$2,922.28
|
|
|
SROM NRH REPL HINGE PIN MED
|
Facility
|
OP
|
$3,320.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.70 |
| Max. Negotiated Rate |
$3,187.94 |
| Rate for Payer: Aetna Commercial |
$2,556.99
|
| Rate for Payer: Anthem Medicaid |
$1,142.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.20
|
| Rate for Payer: Cash Price |
$1,660.38
|
| Rate for Payer: Cigna Commercial |
$2,756.24
|
| Rate for Payer: First Health Commercial |
$3,154.73
|
| Rate for Payer: Humana Commercial |
$2,822.65
|
| Rate for Payer: Humana KY Medicaid |
$1,142.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.44
|
| Rate for Payer: PHCS Commercial |
$3,187.94
|
| Rate for Payer: United Healthcare All Payer |
$2,922.28
|
|
|
SROM NRH REPL HINGE PIN XS/SM
|
Facility
|
IP
|
$4,909.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.17 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$3,779.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,829.02
|
| Rate for Payer: Cash Price |
$2,454.50
|
| Rate for Payer: Cigna Commercial |
$4,074.47
|
| Rate for Payer: First Health Commercial |
$4,663.55
|
| Rate for Payer: Humana Commercial |
$4,172.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,025.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,622.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,319.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.79
|
| Rate for Payer: PHCS Commercial |
$4,712.64
|
| Rate for Payer: United Healthcare All Payer |
$4,319.92
|
|
|
SROM NRH REPL HINGE PIN XS/SM
|
Facility
|
OP
|
$4,909.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.17 |
| Max. Negotiated Rate |
$4,712.64 |
| Rate for Payer: Aetna Commercial |
$3,779.93
|
| Rate for Payer: Anthem Medicaid |
$1,688.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,829.02
|
| Rate for Payer: Cash Price |
$2,454.50
|
| Rate for Payer: Cigna Commercial |
$4,074.47
|
| Rate for Payer: First Health Commercial |
$4,663.55
|
| Rate for Payer: Humana Commercial |
$4,172.65
|
| Rate for Payer: Humana KY Medicaid |
$1,688.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,705.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,025.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,622.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,722.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,319.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.79
|
| Rate for Payer: PHCS Commercial |
$4,712.64
|
| Rate for Payer: United Healthcare All Payer |
$4,319.92
|
|
|
SROM NRH TIB SLEEVE POR 37MM
|
Facility
|
OP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem Medicaid |
$2,979.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Humana KY Medicaid |
$2,979.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
SROM NRH TIB SLEEVE POR 37MM
|
Facility
|
IP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
SROM NRH TIB SLEEVE POR 45MM
|
Facility
|
OP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem Medicaid |
$2,979.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Humana KY Medicaid |
$2,979.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
