|
SROM NRH PLAT ASSY SM 16MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 21MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 21MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 26MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 26MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 31MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 31MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 12MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 12MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 16MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 16MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 21MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 21MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 26MM
|
Facility
|
IP
|
$15,925.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,777.65 |
| Max. Negotiated Rate |
$15,288.48 |
| Rate for Payer: Aetna Commercial |
$12,262.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,421.89
|
| Rate for Payer: Cash Price |
$7,962.75
|
| Rate for Payer: Cigna Commercial |
$13,218.17
|
| Rate for Payer: First Health Commercial |
$15,129.23
|
| Rate for Payer: Humana Commercial |
$13,536.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,058.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,753.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,777.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,014.44
|
| Rate for Payer: Ohio Health Group HMO |
$11,944.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,740.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,855.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,988.59
|
| Rate for Payer: PHCS Commercial |
$15,288.48
|
| Rate for Payer: United Healthcare All Payer |
$14,014.44
|
|
|
SROM NRH PLAT ASSY XS 26MM
|
Facility
|
OP
|
$15,925.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,777.65 |
| Max. Negotiated Rate |
$15,288.48 |
| Rate for Payer: Aetna Commercial |
$12,262.64
|
| Rate for Payer: Anthem Medicaid |
$5,476.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,421.89
|
| Rate for Payer: Cash Price |
$7,962.75
|
| Rate for Payer: Cigna Commercial |
$13,218.17
|
| Rate for Payer: First Health Commercial |
$15,129.23
|
| Rate for Payer: Humana Commercial |
$13,536.67
|
| Rate for Payer: Humana KY Medicaid |
$5,476.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,532.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,058.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,753.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,777.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,586.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,014.44
|
| Rate for Payer: Ohio Health Group HMO |
$11,944.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,740.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,855.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,988.59
|
| Rate for Payer: PHCS Commercial |
$15,288.48
|
| Rate for Payer: United Healthcare All Payer |
$14,014.44
|
|
|
SROM NRH PLAT ASSY XS 31MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY XS 31MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH REPL HINGE BRG QTY 2
|
Facility
|
OP
|
$2,025.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.75 |
| Max. Negotiated Rate |
$1,944.81 |
| Rate for Payer: Aetna Commercial |
$1,559.90
|
| Rate for Payer: Anthem Medicaid |
$696.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.16
|
| Rate for Payer: Cash Price |
$1,012.92
|
| Rate for Payer: Cigna Commercial |
$1,681.45
|
| Rate for Payer: First Health Commercial |
$1,924.55
|
| Rate for Payer: Humana Commercial |
$1,721.96
|
| Rate for Payer: Humana KY Medicaid |
$696.69
|
| Rate for Payer: Kentucky WC Medicaid |
$703.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.83
|
| Rate for Payer: PHCS Commercial |
$1,944.81
|
| Rate for Payer: United Healthcare All Payer |
$1,782.74
|
|
|
SROM NRH REPL HINGE BRG QTY 2
|
Facility
|
IP
|
$2,025.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.75 |
| Max. Negotiated Rate |
$1,944.81 |
| Rate for Payer: Aetna Commercial |
$1,559.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.16
|
| Rate for Payer: Cash Price |
$1,012.92
|
| Rate for Payer: Cigna Commercial |
$1,681.45
|
| Rate for Payer: First Health Commercial |
$1,924.55
|
| Rate for Payer: Humana Commercial |
$1,721.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.83
|
| Rate for Payer: PHCS Commercial |
$1,944.81
|
| Rate for Payer: United Healthcare All Payer |
$1,782.74
|
|
|
SROM NRH REPL HINGE PIN MED
|
Facility
|
IP
|
$3,200.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.25 |
| Max. Negotiated Rate |
$3,072.79 |
| Rate for Payer: Aetna Commercial |
$2,464.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.64
|
| Rate for Payer: Cash Price |
$1,600.41
|
| Rate for Payer: Cigna Commercial |
$2,656.68
|
| Rate for Payer: First Health Commercial |
$3,040.78
|
| Rate for Payer: Humana Commercial |
$2,720.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,362.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.57
|
| Rate for Payer: PHCS Commercial |
$3,072.79
|
| Rate for Payer: United Healthcare All Payer |
$2,816.72
|
|
|
SROM NRH REPL HINGE PIN MED
|
Facility
|
OP
|
$3,200.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.25 |
| Max. Negotiated Rate |
$3,072.79 |
| Rate for Payer: Aetna Commercial |
$2,464.63
|
| Rate for Payer: Anthem Medicaid |
$1,100.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.64
|
| Rate for Payer: Cash Price |
$1,600.41
|
| Rate for Payer: Cigna Commercial |
$2,656.68
|
| Rate for Payer: First Health Commercial |
$3,040.78
|
| Rate for Payer: Humana Commercial |
$2,720.70
|
| Rate for Payer: Humana KY Medicaid |
$1,100.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,362.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.57
|
| Rate for Payer: PHCS Commercial |
$3,072.79
|
| Rate for Payer: United Healthcare All Payer |
$2,816.72
|
|
|
SROM NRH REPL HINGE PIN XS/SM
|
Facility
|
IP
|
$4,902.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.75 |
| Max. Negotiated Rate |
$4,706.40 |
| Rate for Payer: Aetna Commercial |
$3,774.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.95
|
| Rate for Payer: Cash Price |
$2,451.25
|
| Rate for Payer: Cigna Commercial |
$4,069.07
|
| Rate for Payer: First Health Commercial |
$4,657.38
|
| Rate for Payer: Humana Commercial |
$4,167.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,314.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,922.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,265.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,382.72
|
| Rate for Payer: PHCS Commercial |
$4,706.40
|
| Rate for Payer: United Healthcare All Payer |
$4,314.20
|
|
|
SROM NRH REPL HINGE PIN XS/SM
|
Facility
|
OP
|
$4,902.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.75 |
| Max. Negotiated Rate |
$4,706.40 |
| Rate for Payer: Aetna Commercial |
$3,774.93
|
| Rate for Payer: Anthem Medicaid |
$1,685.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.95
|
| Rate for Payer: Cash Price |
$2,451.25
|
| Rate for Payer: Cigna Commercial |
$4,069.07
|
| Rate for Payer: First Health Commercial |
$4,657.38
|
| Rate for Payer: Humana Commercial |
$4,167.12
|
| Rate for Payer: Humana KY Medicaid |
$1,685.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,703.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,020.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,618.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,314.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,922.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,265.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,382.72
|
| Rate for Payer: PHCS Commercial |
$4,706.40
|
| Rate for Payer: United Healthcare All Payer |
$4,314.20
|
|
|
SROM NRH TIB SLEEVE POR 37MM
|
Facility
|
IP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
SROM NRH TIB SLEEVE POR 37MM
|
Facility
|
OP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem Medicaid |
$3,048.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Humana KY Medicaid |
$3,048.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
