|
ANATOMICL SHLDR KEEL GLENOID M
|
Facility
|
IP
|
$6,716.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$873.14 |
| Max. Negotiated Rate |
$6,447.79 |
| Rate for Payer: Aetna Commercial |
$5,171.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,238.83
|
| Rate for Payer: Cash Price |
$3,358.22
|
| Rate for Payer: Cigna Commercial |
$5,574.65
|
| Rate for Payer: First Health Commercial |
$6,380.63
|
| Rate for Payer: Humana Commercial |
$5,708.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,507.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,956.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,014.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,910.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,037.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,343.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$873.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,082.10
|
| Rate for Payer: PHCS Commercial |
$6,447.79
|
| Rate for Payer: United Healthcare All Payer |
$5,910.48
|
|
|
ANATOMIC RAD HEAD 20.0MM L
|
Facility
|
IP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 20.0MM L
|
Facility
|
OP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem Medicaid |
$3,945.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Humana KY Medicaid |
$3,945.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,985.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 20.0MM R
|
Facility
|
OP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem Medicaid |
$3,945.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Humana KY Medicaid |
$3,945.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,985.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 20.0MM R
|
Facility
|
IP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 22.0MM L
|
Facility
|
IP
|
$12,487.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,623.32 |
| Max. Negotiated Rate |
$11,987.57 |
| Rate for Payer: Aetna Commercial |
$9,615.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,739.90
|
| Rate for Payer: Cash Price |
$6,243.52
|
| Rate for Payer: Cigna Commercial |
$10,364.25
|
| Rate for Payer: First Health Commercial |
$11,862.70
|
| Rate for Payer: Humana Commercial |
$10,613.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,239.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,215.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,746.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,988.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,365.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,623.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,870.99
|
| Rate for Payer: PHCS Commercial |
$11,987.57
|
| Rate for Payer: United Healthcare All Payer |
$10,988.60
|
|
|
ANATOMIC RAD HEAD 22.0MM L
|
Facility
|
OP
|
$12,487.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,623.32 |
| Max. Negotiated Rate |
$11,987.57 |
| Rate for Payer: Aetna Commercial |
$9,615.03
|
| Rate for Payer: Anthem Medicaid |
$4,294.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,739.90
|
| Rate for Payer: Cash Price |
$6,243.52
|
| Rate for Payer: Cigna Commercial |
$10,364.25
|
| Rate for Payer: First Health Commercial |
$11,862.70
|
| Rate for Payer: Humana Commercial |
$10,613.99
|
| Rate for Payer: Humana KY Medicaid |
$4,294.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,338.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,239.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,215.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,746.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,380.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,988.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,365.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,623.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,870.99
|
| Rate for Payer: PHCS Commercial |
$11,987.57
|
| Rate for Payer: United Healthcare All Payer |
$10,988.60
|
|
|
ANATOMIC RAD HEAD 22.0MM R
|
Facility
|
OP
|
$13,107.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.98 |
| Max. Negotiated Rate |
$12,583.25 |
| Rate for Payer: Aetna Commercial |
$10,092.81
|
| Rate for Payer: Anthem Medicaid |
$4,507.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,223.89
|
| Rate for Payer: Cash Price |
$6,553.77
|
| Rate for Payer: Cigna Commercial |
$10,879.27
|
| Rate for Payer: First Health Commercial |
$12,452.17
|
| Rate for Payer: Humana Commercial |
$11,141.42
|
| Rate for Payer: Humana KY Medicaid |
$4,507.69
|
| Rate for Payer: Kentucky WC Medicaid |
$4,553.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,748.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,673.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,932.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,534.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,830.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,621.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,703.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,063.34
|
| Rate for Payer: PHCS Commercial |
$12,583.25
|
| Rate for Payer: United Healthcare All Payer |
$11,534.64
|
|
|
ANATOMIC RAD HEAD 22.0MM R
|
Facility
|
IP
|
$13,107.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,703.98 |
| Max. Negotiated Rate |
$12,583.25 |
| Rate for Payer: Aetna Commercial |
$10,092.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,223.89
|
| Rate for Payer: Cash Price |
$6,553.77
|
| Rate for Payer: Cigna Commercial |
$10,879.27
|
| Rate for Payer: First Health Commercial |
$12,452.17
|
| Rate for Payer: Humana Commercial |
$11,141.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,748.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,673.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,932.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,534.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,830.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,621.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,703.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,063.34
|
| Rate for Payer: PHCS Commercial |
$12,583.25
|
| Rate for Payer: United Healthcare All Payer |
$11,534.64
|
|
|
ANATOMIC RAD HEAD 24.0MM L
|
Facility
|
OP
|
$16,159.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.70 |
| Max. Negotiated Rate |
$15,512.83 |
| Rate for Payer: Aetna Commercial |
$12,442.58
|
| Rate for Payer: Anthem Medicaid |
$5,557.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,604.18
|
| Rate for Payer: Cash Price |
$8,079.60
|
| Rate for Payer: Cigna Commercial |
$13,412.14
|
| Rate for Payer: First Health Commercial |
$15,351.24
|
| Rate for Payer: Humana Commercial |
$13,735.32
|
| Rate for Payer: Humana KY Medicaid |
$5,557.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,613.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,250.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,847.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,668.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,220.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,119.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,100.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,009.35
|
| Rate for Payer: PHCS Commercial |
$15,512.83
|
| Rate for Payer: United Healthcare All Payer |
$14,220.10
|
|
|
ANATOMIC RAD HEAD 24.0MM L
|
Facility
|
IP
|
$16,159.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.70 |
| Max. Negotiated Rate |
$15,512.83 |
| Rate for Payer: Aetna Commercial |
$12,442.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,604.18
|
| Rate for Payer: Cash Price |
$8,079.60
|
| Rate for Payer: Cigna Commercial |
$13,412.14
|
| Rate for Payer: First Health Commercial |
$15,351.24
|
| Rate for Payer: Humana Commercial |
$13,735.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,250.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,847.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,220.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,119.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,100.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,009.35
|
| Rate for Payer: PHCS Commercial |
$15,512.83
|
| Rate for Payer: United Healthcare All Payer |
$14,220.10
|
|
|
ANATOMIC RAD HEAD 24.0MM R
|
Facility
|
OP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem Medicaid |
$3,945.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Humana KY Medicaid |
$3,945.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,985.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 24.0MM R
|
Facility
|
IP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 26.0MM L
|
Facility
|
OP
|
$16,159.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.70 |
| Max. Negotiated Rate |
$15,512.83 |
| Rate for Payer: Aetna Commercial |
$12,442.58
|
| Rate for Payer: Anthem Medicaid |
$5,557.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,604.18
|
| Rate for Payer: Cash Price |
$8,079.60
|
| Rate for Payer: Cigna Commercial |
$13,412.14
|
| Rate for Payer: First Health Commercial |
$15,351.24
|
| Rate for Payer: Humana Commercial |
$13,735.32
|
| Rate for Payer: Humana KY Medicaid |
$5,557.15
|
| Rate for Payer: Kentucky WC Medicaid |
$5,613.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,250.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,847.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,668.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,220.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,119.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,100.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,009.35
|
| Rate for Payer: PHCS Commercial |
$15,512.83
|
| Rate for Payer: United Healthcare All Payer |
$14,220.10
|
|
|
ANATOMIC RAD HEAD 26.0MM L
|
Facility
|
IP
|
$16,159.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,100.70 |
| Max. Negotiated Rate |
$15,512.83 |
| Rate for Payer: Aetna Commercial |
$12,442.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,604.18
|
| Rate for Payer: Cash Price |
$8,079.60
|
| Rate for Payer: Cigna Commercial |
$13,412.14
|
| Rate for Payer: First Health Commercial |
$15,351.24
|
| Rate for Payer: Humana Commercial |
$13,735.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,250.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,847.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,220.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,119.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,100.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,009.35
|
| Rate for Payer: PHCS Commercial |
$15,512.83
|
| Rate for Payer: United Healthcare All Payer |
$14,220.10
|
|
|
ANATOMIC RAD HEAD 26.0MM R
|
Facility
|
OP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem Medicaid |
$3,945.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Humana KY Medicaid |
$3,945.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,985.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 26.0MM R
|
Facility
|
IP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 28.0MM L
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
ANATOMIC RAD HEAD 28.0MM L
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
ANATOMIC RAD HEAD 28.0MM R
|
Facility
|
IP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD 28.0MM R
|
Facility
|
OP
|
$11,472.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.41 |
| Max. Negotiated Rate |
$11,013.46 |
| Rate for Payer: Aetna Commercial |
$8,833.71
|
| Rate for Payer: Anthem Medicaid |
$3,945.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,948.43
|
| Rate for Payer: Cash Price |
$5,736.18
|
| Rate for Payer: Cigna Commercial |
$9,522.05
|
| Rate for Payer: First Health Commercial |
$10,898.73
|
| Rate for Payer: Humana Commercial |
$9,751.50
|
| Rate for Payer: Humana KY Medicaid |
$3,945.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,985.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,407.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,466.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,441.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,095.67
|
| Rate for Payer: Ohio Health Group HMO |
$8,604.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,294.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,491.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,556.43
|
| Rate for Payer: PHCS Commercial |
$11,013.46
|
| Rate for Payer: United Healthcare All Payer |
$10,095.67
|
|
|
ANATOMIC RAD HEAD STEM 10*2.0M
|
Facility
|
OP
|
$8,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.41 |
| Max. Negotiated Rate |
$8,059.63 |
| Rate for Payer: Aetna Commercial |
$6,464.50
|
| Rate for Payer: Anthem Medicaid |
$2,887.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,548.45
|
| Rate for Payer: Cash Price |
$4,197.73
|
| Rate for Payer: Cigna Commercial |
$6,968.22
|
| Rate for Payer: First Health Commercial |
$7,975.68
|
| Rate for Payer: Humana Commercial |
$7,136.13
|
| Rate for Payer: Humana KY Medicaid |
$2,887.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,916.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,884.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,195.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,518.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,945.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,388.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,296.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,679.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,091.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,602.59
|
| Rate for Payer: PHCS Commercial |
$8,059.63
|
| Rate for Payer: United Healthcare All Payer |
$7,388.00
|
|
|
ANATOMIC RAD HEAD STEM 10*2.0M
|
Facility
|
IP
|
$8,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.41 |
| Max. Negotiated Rate |
$8,059.63 |
| Rate for Payer: Aetna Commercial |
$6,464.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,548.45
|
| Rate for Payer: Cash Price |
$4,197.73
|
| Rate for Payer: Cigna Commercial |
$6,968.22
|
| Rate for Payer: First Health Commercial |
$7,975.68
|
| Rate for Payer: Humana Commercial |
$7,136.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,884.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,195.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,518.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,388.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,296.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,679.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,091.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,602.59
|
| Rate for Payer: PHCS Commercial |
$8,059.63
|
| Rate for Payer: United Healthcare All Payer |
$7,388.00
|
|
|
ANATOMIC RAD HEAD STEM 6*0.0MM
|
Facility
|
IP
|
$7,778.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.22 |
| Max. Negotiated Rate |
$7,467.46 |
| Rate for Payer: Aetna Commercial |
$5,989.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,067.31
|
| Rate for Payer: Cash Price |
$3,889.30
|
| Rate for Payer: Cigna Commercial |
$6,456.24
|
| Rate for Payer: First Health Commercial |
$7,389.67
|
| Rate for Payer: Humana Commercial |
$6,611.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,740.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,333.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,845.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,833.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,411.37
|
| Rate for Payer: PHCS Commercial |
$7,467.46
|
| Rate for Payer: United Healthcare All Payer |
$6,845.17
|
|
|
ANATOMIC RAD HEAD STEM 6*0.0MM
|
Facility
|
OP
|
$7,778.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.22 |
| Max. Negotiated Rate |
$7,467.46 |
| Rate for Payer: Aetna Commercial |
$5,989.52
|
| Rate for Payer: Anthem Medicaid |
$2,675.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,067.31
|
| Rate for Payer: Cash Price |
$3,889.30
|
| Rate for Payer: Cigna Commercial |
$6,456.24
|
| Rate for Payer: First Health Commercial |
$7,389.67
|
| Rate for Payer: Humana Commercial |
$6,611.81
|
| Rate for Payer: Humana KY Medicaid |
$2,675.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,702.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,740.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,333.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,728.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,845.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,833.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,411.37
|
| Rate for Payer: PHCS Commercial |
$7,467.46
|
| Rate for Payer: United Healthcare All Payer |
$6,845.17
|
|
