|
HEAD RINGLOC BI-POLAR 28*41MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*41MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*43MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*43MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*47MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*47MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*48MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*48MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*53MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*53MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*54MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*54MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*55MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*55MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*56MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*56MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*57MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*57MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*58MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*58MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*59MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*59MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*60MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*60MM
|
Facility
|
IP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
|
HEAD RINGLOC BI-POLAR 28*61MM
|
Facility
|
OP
|
$7,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.34 |
| Max. Negotiated Rate |
$7,313.28 |
| Rate for Payer: Aetna Commercial |
$5,865.86
|
| Rate for Payer: Anthem Medicaid |
$2,619.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.04
|
| Rate for Payer: Cash Price |
$3,809.00
|
| Rate for Payer: Cigna Commercial |
$6,322.94
|
| Rate for Payer: First Health Commercial |
$7,237.10
|
| Rate for Payer: Humana Commercial |
$6,475.30
|
| Rate for Payer: Humana KY Medicaid |
$2,619.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,246.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,703.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.58
|
| Rate for Payer: PHCS Commercial |
$7,313.28
|
| Rate for Payer: United Healthcare All Payer |
$6,703.84
|
|
