|
HEAD RINGLOC BI-POLAR 28*61MM
|
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 TRIAL 43/15 FRACTURE STEM
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 43/15 FRACTURE STEM
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 46/17 FRACTURE STEM
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 46/17 FRACTURE STEM
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 48/17 FRACTURE STEM
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 48/17 FRACTURE STEM
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 50/19 FRACTURE STEM
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 50/19 FRACTURE STEM
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 51/22 FRACTURE STEM
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD TRIAL 51/22 FRACTURE STEM
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
HEAD V40 TAPER LFIT 22MM +0
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
HEAD V40 TAPER LFIT 22MM +0
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
HEAD V40 TAPER LFIT 22MM +3
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
HEAD V40 TAPER LFIT 22MM +3
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
HEAD V40 TAPER LFIT 22MM +8
|
Facility
|
IP
|
$4,498.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.86 |
| Max. Negotiated Rate |
$4,318.98 |
| Rate for Payer: Aetna Commercial |
$3,464.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.17
|
| Rate for Payer: Cash Price |
$2,249.47
|
| Rate for Payer: Cigna Commercial |
$3,734.12
|
| Rate for Payer: First Health Commercial |
$4,273.99
|
| Rate for Payer: Humana Commercial |
$3,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.67
|
| Rate for Payer: PHCS Commercial |
$4,318.98
|
| Rate for Payer: United Healthcare All Payer |
$3,959.07
|
|
|
HEAD V40 TAPER LFIT 22MM +8
|
Facility
|
OP
|
$4,498.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.86 |
| Max. Negotiated Rate |
$4,318.98 |
| Rate for Payer: Aetna Commercial |
$3,464.18
|
| Rate for Payer: Anthem Medicaid |
$1,547.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.17
|
| Rate for Payer: Cash Price |
$2,249.47
|
| Rate for Payer: Cigna Commercial |
$3,734.12
|
| Rate for Payer: First Health Commercial |
$4,273.99
|
| Rate for Payer: Humana Commercial |
$3,824.10
|
| Rate for Payer: Humana KY Medicaid |
$1,547.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.67
|
| Rate for Payer: PHCS Commercial |
$4,318.98
|
| Rate for Payer: United Healthcare All Payer |
$3,959.07
|
|
|
HEAD V40 TAPER LFIT 26MM +12
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.80
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
HEAD V40 TAPER LFIT 26MM +12
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem Medicaid |
$1,575.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Humana KY Medicaid |
$1,575.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,591.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,606.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.80
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
HEAD V40 TAPER LFIT 26MM +16
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.80
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
HEAD V40 TAPER LFIT 26MM +16
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.40 |
| Max. Negotiated Rate |
$4,396.80 |
| Rate for Payer: Aetna Commercial |
$3,526.60
|
| Rate for Payer: Anthem Medicaid |
$1,575.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,572.40
|
| Rate for Payer: Cash Price |
$2,290.00
|
| Rate for Payer: Cigna Commercial |
$3,801.40
|
| Rate for Payer: First Health Commercial |
$4,351.00
|
| Rate for Payer: Humana Commercial |
$3,893.00
|
| Rate for Payer: Humana KY Medicaid |
$1,575.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,591.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,755.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,380.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,606.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,030.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.80
|
| Rate for Payer: PHCS Commercial |
$4,396.80
|
| Rate for Payer: United Healthcare All Payer |
$4,030.40
|
|
|
HEAD V40 TAPER LFIT 26MM -3
|
Facility
|
OP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem Medicaid |
$1,722.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Humana KY Medicaid |
$1,722.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
HEAD V40 TAPER LFIT 26MM -3
|
Facility
|
IP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
HEAD V40 TAPER LFIT 26MM +4
|
Facility
|
OP
|
$4,522.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.88 |
| Max. Negotiated Rate |
$4,341.26 |
| Rate for Payer: Aetna Commercial |
$3,482.06
|
| Rate for Payer: Anthem Medicaid |
$1,555.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,527.28
|
| Rate for Payer: Cash Price |
$2,261.07
|
| Rate for Payer: Cigna Commercial |
$3,753.38
|
| Rate for Payer: First Health Commercial |
$4,296.04
|
| Rate for Payer: Humana Commercial |
$3,843.83
|
| Rate for Payer: Humana KY Medicaid |
$1,555.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,570.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,708.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,337.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,586.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,979.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,391.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.87
|
| Rate for Payer: PHCS Commercial |
$4,341.26
|
| Rate for Payer: United Healthcare All Payer |
$3,979.49
|
|
|
HEAD V40 TAPER LFIT 26MM +4
|
Facility
|
IP
|
$4,522.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.88 |
| Max. Negotiated Rate |
$4,341.26 |
| Rate for Payer: Aetna Commercial |
$3,482.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,527.28
|
| Rate for Payer: Cash Price |
$2,261.07
|
| Rate for Payer: Cigna Commercial |
$3,753.38
|
| Rate for Payer: First Health Commercial |
$4,296.04
|
| Rate for Payer: Humana Commercial |
$3,843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,708.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,337.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,979.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,391.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.87
|
| Rate for Payer: PHCS Commercial |
$4,341.26
|
| Rate for Payer: United Healthcare All Payer |
$3,979.49
|
|
