|
ANATOMICAL SHOULDER BALL TAPER
|
Facility
|
OP
|
$7,387.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.19 |
| Max. Negotiated Rate |
$7,091.81 |
| Rate for Payer: Aetna Commercial |
$5,688.22
|
| Rate for Payer: Anthem Medicaid |
$2,540.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,762.09
|
| Rate for Payer: Cash Price |
$3,693.65
|
| Rate for Payer: Cigna Commercial |
$6,131.46
|
| Rate for Payer: First Health Commercial |
$7,017.94
|
| Rate for Payer: Humana Commercial |
$6,279.20
|
| Rate for Payer: Humana KY Medicaid |
$2,540.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,057.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,451.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,591.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,500.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,540.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,909.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,426.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,097.24
|
| Rate for Payer: PHCS Commercial |
$7,091.81
|
| Rate for Payer: United Healthcare All Payer |
$6,500.82
|
|
|
ANATOMICAL SHOULDER BALL TPR
|
Facility
|
IP
|
$7,753.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,326.13 |
| Max. Negotiated Rate |
$7,443.61 |
| Rate for Payer: Aetna Commercial |
$5,970.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,047.93
|
| Rate for Payer: Cash Price |
$3,876.88
|
| Rate for Payer: Cigna Commercial |
$6,435.62
|
| Rate for Payer: First Health Commercial |
$7,366.07
|
| Rate for Payer: Humana Commercial |
$6,590.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,358.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,722.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,326.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,823.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,815.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,203.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,745.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,350.09
|
| Rate for Payer: PHCS Commercial |
$7,443.61
|
| Rate for Payer: United Healthcare All Payer |
$6,823.31
|
|
|
ANATOMICAL SHOULDER BALL TPR
|
Facility
|
OP
|
$7,753.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,326.13 |
| Max. Negotiated Rate |
$7,443.61 |
| Rate for Payer: Aetna Commercial |
$5,970.40
|
| Rate for Payer: Anthem Medicaid |
$2,666.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,047.93
|
| Rate for Payer: Cash Price |
$3,876.88
|
| Rate for Payer: Cigna Commercial |
$6,435.62
|
| Rate for Payer: First Health Commercial |
$7,366.07
|
| Rate for Payer: Humana Commercial |
$6,590.70
|
| Rate for Payer: Humana KY Medicaid |
$2,666.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,693.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,358.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,722.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,326.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,720.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,823.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,815.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,203.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,745.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,350.09
|
| Rate for Payer: PHCS Commercial |
$7,443.61
|
| Rate for Payer: United Healthcare All Payer |
$6,823.31
|
|
|
ANATOMICL SHLDR KEEL GLENOID L
|
Facility
|
IP
|
$6,918.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.59 |
| Max. Negotiated Rate |
$6,641.89 |
| Rate for Payer: Aetna Commercial |
$5,327.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.54
|
| Rate for Payer: Cash Price |
$3,459.32
|
| Rate for Payer: Cigna Commercial |
$5,742.47
|
| Rate for Payer: First Health Commercial |
$6,572.71
|
| Rate for Payer: Humana Commercial |
$5,880.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,105.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,088.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,188.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,019.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,773.86
|
| Rate for Payer: PHCS Commercial |
$6,641.89
|
| Rate for Payer: United Healthcare All Payer |
$6,088.40
|
|
|
ANATOMICL SHLDR KEEL GLENOID L
|
Facility
|
OP
|
$6,918.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,075.59 |
| Max. Negotiated Rate |
$6,641.89 |
| Rate for Payer: Aetna Commercial |
$5,327.35
|
| Rate for Payer: Anthem Medicaid |
$2,379.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.54
|
| Rate for Payer: Cash Price |
$3,459.32
|
| Rate for Payer: Cigna Commercial |
$5,742.47
|
| Rate for Payer: First Health Commercial |
$6,572.71
|
| Rate for Payer: Humana Commercial |
$5,880.84
|
| Rate for Payer: Humana KY Medicaid |
$2,379.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,403.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,105.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,427.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,088.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,188.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,019.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,773.86
|
| Rate for Payer: PHCS Commercial |
$6,641.89
|
| Rate for Payer: United Healthcare All Payer |
$6,088.40
|
|
|
ANATOMICL SHLDR KEEL GLENOID M
|
Facility
|
OP
|
$6,916.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.93 |
| Max. Negotiated Rate |
$6,639.79 |
| Rate for Payer: Aetna Commercial |
$5,325.67
|
| Rate for Payer: Anthem Medicaid |
$2,378.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,394.83
|
| Rate for Payer: Cash Price |
$3,458.22
|
| Rate for Payer: Cigna Commercial |
$5,740.65
|
| Rate for Payer: First Health Commercial |
$6,570.63
|
| Rate for Payer: Humana Commercial |
$5,878.98
|
| Rate for Payer: Humana KY Medicaid |
$2,378.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,402.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,671.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,104.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,074.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,426.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,086.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,187.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,533.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,017.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,772.35
|
| Rate for Payer: PHCS Commercial |
$6,639.79
|
| Rate for Payer: United Healthcare All Payer |
$6,086.48
|
|
|
ANATOMICL SHLDR KEEL GLENOID M
|
Facility
|
IP
|
$6,916.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.93 |
| Max. Negotiated Rate |
$6,639.79 |
| Rate for Payer: Aetna Commercial |
$5,325.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,394.83
|
| Rate for Payer: Cash Price |
$3,458.22
|
| Rate for Payer: Cigna Commercial |
$5,740.65
|
| Rate for Payer: First Health Commercial |
$6,570.63
|
| Rate for Payer: Humana Commercial |
$5,878.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,671.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,104.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,074.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,086.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,187.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,533.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,017.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,772.35
|
| Rate for Payer: PHCS Commercial |
$6,639.79
|
| Rate for Payer: United Healthcare All Payer |
$6,086.48
|
|
|
ANATOMIC RAD HEAD 20.0MM L
|
Facility
|
IP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 20.0MM L
|
Facility
|
OP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem Medicaid |
$4,029.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Humana KY Medicaid |
$4,029.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,070.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,110.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 20.0MM R
|
Facility
|
OP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem Medicaid |
$4,029.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Humana KY Medicaid |
$4,029.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,070.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,110.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 20.0MM R
|
Facility
|
IP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 22.0MM L
|
Facility
|
IP
|
$12,737.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,821.22 |
| Max. Negotiated Rate |
$12,227.89 |
| Rate for Payer: Aetna Commercial |
$9,807.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,935.16
|
| Rate for Payer: Cash Price |
$6,368.70
|
| Rate for Payer: Cigna Commercial |
$10,572.03
|
| Rate for Payer: First Health Commercial |
$12,100.52
|
| Rate for Payer: Humana Commercial |
$10,826.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,444.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,821.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,208.90
|
| Rate for Payer: Ohio Health Group HMO |
$9,553.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,189.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,081.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,788.80
|
| Rate for Payer: PHCS Commercial |
$12,227.89
|
| Rate for Payer: United Healthcare All Payer |
$11,208.90
|
|
|
ANATOMIC RAD HEAD 22.0MM L
|
Facility
|
OP
|
$12,737.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,821.22 |
| Max. Negotiated Rate |
$12,227.89 |
| Rate for Payer: Aetna Commercial |
$9,807.79
|
| Rate for Payer: Anthem Medicaid |
$4,380.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,935.16
|
| Rate for Payer: Cash Price |
$6,368.70
|
| Rate for Payer: Cigna Commercial |
$10,572.03
|
| Rate for Payer: First Health Commercial |
$12,100.52
|
| Rate for Payer: Humana Commercial |
$10,826.78
|
| Rate for Payer: Humana KY Medicaid |
$4,380.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,424.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,444.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,400.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,821.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,468.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,208.90
|
| Rate for Payer: Ohio Health Group HMO |
$9,553.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,189.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,081.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,788.80
|
| Rate for Payer: PHCS Commercial |
$12,227.89
|
| Rate for Payer: United Healthcare All Payer |
$11,208.90
|
|
|
ANATOMIC RAD HEAD 22.0MM R
|
Facility
|
IP
|
$13,361.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,008.39 |
| Max. Negotiated Rate |
$12,826.84 |
| Rate for Payer: Aetna Commercial |
$10,288.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,421.81
|
| Rate for Payer: Cash Price |
$6,680.65
|
| Rate for Payer: Cigna Commercial |
$11,089.87
|
| Rate for Payer: First Health Commercial |
$12,693.23
|
| Rate for Payer: Humana Commercial |
$11,357.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,956.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,860.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,757.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,020.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,689.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,624.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,219.29
|
| Rate for Payer: PHCS Commercial |
$12,826.84
|
| Rate for Payer: United Healthcare All Payer |
$11,757.94
|
|
|
ANATOMIC RAD HEAD 22.0MM R
|
Facility
|
OP
|
$13,361.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,008.39 |
| Max. Negotiated Rate |
$12,826.84 |
| Rate for Payer: Aetna Commercial |
$10,288.19
|
| Rate for Payer: Anthem Medicaid |
$4,594.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,421.81
|
| Rate for Payer: Cash Price |
$6,680.65
|
| Rate for Payer: Cigna Commercial |
$11,089.87
|
| Rate for Payer: First Health Commercial |
$12,693.23
|
| Rate for Payer: Humana Commercial |
$11,357.10
|
| Rate for Payer: Humana KY Medicaid |
$4,594.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,641.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,956.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,860.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,008.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,687.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,757.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,020.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,689.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,624.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,219.29
|
| Rate for Payer: PHCS Commercial |
$12,826.84
|
| Rate for Payer: United Healthcare All Payer |
$11,757.94
|
|
|
ANATOMIC RAD HEAD 24.0MM L
|
Facility
|
OP
|
$16,691.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,007.42 |
| Max. Negotiated Rate |
$16,023.74 |
| Rate for Payer: Aetna Commercial |
$12,852.38
|
| Rate for Payer: Anthem Medicaid |
$5,740.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,019.29
|
| Rate for Payer: Cash Price |
$8,345.70
|
| Rate for Payer: Cigna Commercial |
$13,853.86
|
| Rate for Payer: First Health Commercial |
$15,856.83
|
| Rate for Payer: Humana Commercial |
$14,187.69
|
| Rate for Payer: Humana KY Medicaid |
$5,740.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,798.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,686.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,318.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,007.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,855.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,688.43
|
| Rate for Payer: Ohio Health Group HMO |
$12,518.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,353.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,521.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,517.07
|
| Rate for Payer: PHCS Commercial |
$16,023.74
|
| Rate for Payer: United Healthcare All Payer |
$14,688.43
|
|
|
ANATOMIC RAD HEAD 24.0MM L
|
Facility
|
IP
|
$16,691.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,007.42 |
| Max. Negotiated Rate |
$16,023.74 |
| Rate for Payer: Aetna Commercial |
$12,852.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,019.29
|
| Rate for Payer: Cash Price |
$8,345.70
|
| Rate for Payer: Cigna Commercial |
$13,853.86
|
| Rate for Payer: First Health Commercial |
$15,856.83
|
| Rate for Payer: Humana Commercial |
$14,187.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,686.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,318.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,007.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,688.43
|
| Rate for Payer: Ohio Health Group HMO |
$12,518.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,353.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,521.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,517.07
|
| Rate for Payer: PHCS Commercial |
$16,023.74
|
| Rate for Payer: United Healthcare All Payer |
$14,688.43
|
|
|
ANATOMIC RAD HEAD 24.0MM R
|
Facility
|
IP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 24.0MM R
|
Facility
|
OP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem Medicaid |
$4,029.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Humana KY Medicaid |
$4,029.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,070.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,110.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 26.0MM L
|
Facility
|
OP
|
$16,691.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,007.42 |
| Max. Negotiated Rate |
$16,023.74 |
| Rate for Payer: Aetna Commercial |
$12,852.38
|
| Rate for Payer: Anthem Medicaid |
$5,740.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,019.29
|
| Rate for Payer: Cash Price |
$8,345.70
|
| Rate for Payer: Cigna Commercial |
$13,853.86
|
| Rate for Payer: First Health Commercial |
$15,856.83
|
| Rate for Payer: Humana Commercial |
$14,187.69
|
| Rate for Payer: Humana KY Medicaid |
$5,740.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,798.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,686.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,318.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,007.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,855.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,688.43
|
| Rate for Payer: Ohio Health Group HMO |
$12,518.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,353.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,521.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,517.07
|
| Rate for Payer: PHCS Commercial |
$16,023.74
|
| Rate for Payer: United Healthcare All Payer |
$14,688.43
|
|
|
ANATOMIC RAD HEAD 26.0MM L
|
Facility
|
IP
|
$16,691.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,007.42 |
| Max. Negotiated Rate |
$16,023.74 |
| Rate for Payer: Aetna Commercial |
$12,852.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,019.29
|
| Rate for Payer: Cash Price |
$8,345.70
|
| Rate for Payer: Cigna Commercial |
$13,853.86
|
| Rate for Payer: First Health Commercial |
$15,856.83
|
| Rate for Payer: Humana Commercial |
$14,187.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,686.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,318.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,007.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,688.43
|
| Rate for Payer: Ohio Health Group HMO |
$12,518.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,353.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,521.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,517.07
|
| Rate for Payer: PHCS Commercial |
$16,023.74
|
| Rate for Payer: United Healthcare All Payer |
$14,688.43
|
|
|
ANATOMIC RAD HEAD 26.0MM R
|
Facility
|
IP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 26.0MM R
|
Facility
|
OP
|
$11,717.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,515.14 |
| Max. Negotiated Rate |
$11,248.44 |
| Rate for Payer: Aetna Commercial |
$9,022.19
|
| Rate for Payer: Anthem Medicaid |
$4,029.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.36
|
| Rate for Payer: Cash Price |
$5,858.56
|
| Rate for Payer: Cigna Commercial |
$9,725.22
|
| Rate for Payer: First Health Commercial |
$11,131.27
|
| Rate for Payer: Humana Commercial |
$9,959.56
|
| Rate for Payer: Humana KY Medicaid |
$4,029.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,070.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,110.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,787.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,373.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,193.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,084.82
|
| Rate for Payer: PHCS Commercial |
$11,248.44
|
| Rate for Payer: United Healthcare All Payer |
$10,311.07
|
|
|
ANATOMIC RAD HEAD 28.0MM L
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
ANATOMIC RAD HEAD 28.0MM L
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
