|
HEAD V40 TAPER LFIT 26MM +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 26MM +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 28MM +0
|
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 28MM +0
|
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 28MM +12
|
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 28MM +12
|
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 28MM +16
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
HEAD V40 TAPER LFIT 28MM +16
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
HEAD V40 TAPER LFIT 28MM +4
|
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 28MM +4
|
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 28MM -4
|
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 28MM -4
|
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 28MM +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 28MM +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 32MM +0
|
Facility
|
OP
|
$4,700.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.05 |
| Max. Negotiated Rate |
$4,512.38 |
| Rate for Payer: Aetna Commercial |
$3,619.31
|
| Rate for Payer: Anthem Medicaid |
$1,616.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.31
|
| Rate for Payer: Cash Price |
$2,350.20
|
| Rate for Payer: Cigna Commercial |
$3,901.33
|
| Rate for Payer: First Health Commercial |
$4,465.38
|
| Rate for Payer: Humana Commercial |
$3,995.34
|
| Rate for Payer: Humana KY Medicaid |
$1,616.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.12
|
| Rate for Payer: PHCS Commercial |
$4,512.38
|
| Rate for Payer: United Healthcare All Payer |
$4,136.35
|
|
|
HEAD V40 TAPER LFIT 32MM +0
|
Facility
|
IP
|
$4,700.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.05 |
| Max. Negotiated Rate |
$4,512.38 |
| Rate for Payer: Aetna Commercial |
$3,619.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.31
|
| Rate for Payer: Cash Price |
$2,350.20
|
| Rate for Payer: Cigna Commercial |
$3,901.33
|
| Rate for Payer: First Health Commercial |
$4,465.38
|
| Rate for Payer: Humana Commercial |
$3,995.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.12
|
| Rate for Payer: PHCS Commercial |
$4,512.38
|
| Rate for Payer: United Healthcare All Payer |
$4,136.35
|
|
|
HEAD V40 TAPER LFIT 32MM +12
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
HEAD V40 TAPER LFIT 32MM +12
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
HEAD V40 TAPER LFIT 32MM +16
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
HEAD V40 TAPER LFIT 32MM +16
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
HEAD V40 TAPER LFIT 32MM +4
|
Facility
|
IP
|
$5,319.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.50 |
| Max. Negotiated Rate |
$5,106.43 |
| Rate for Payer: Aetna Commercial |
$4,095.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.98
|
| Rate for Payer: Cash Price |
$2,659.60
|
| Rate for Payer: Cigna Commercial |
$4,414.94
|
| Rate for Payer: First Health Commercial |
$5,053.24
|
| Rate for Payer: Humana Commercial |
$4,521.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,989.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.95
|
| Rate for Payer: PHCS Commercial |
$5,106.43
|
| Rate for Payer: United Healthcare All Payer |
$4,680.90
|
|
|
HEAD V40 TAPER LFIT 32MM +4
|
Facility
|
OP
|
$5,319.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.50 |
| Max. Negotiated Rate |
$5,106.43 |
| Rate for Payer: Aetna Commercial |
$4,095.78
|
| Rate for Payer: Anthem Medicaid |
$1,829.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.98
|
| Rate for Payer: Cash Price |
$2,659.60
|
| Rate for Payer: Cigna Commercial |
$4,414.94
|
| Rate for Payer: First Health Commercial |
$5,053.24
|
| Rate for Payer: Humana Commercial |
$4,521.32
|
| Rate for Payer: Humana KY Medicaid |
$1,829.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,847.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,865.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,989.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.95
|
| Rate for Payer: PHCS Commercial |
$5,106.43
|
| Rate for Payer: United Healthcare All Payer |
$4,680.90
|
|
|
HEAD V40 TAPER LFIT 32MM -4
|
Facility
|
OP
|
$5,319.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.50 |
| Max. Negotiated Rate |
$5,106.43 |
| Rate for Payer: Aetna Commercial |
$4,095.78
|
| Rate for Payer: Anthem Medicaid |
$1,829.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.98
|
| Rate for Payer: Cash Price |
$2,659.60
|
| Rate for Payer: Cigna Commercial |
$4,414.94
|
| Rate for Payer: First Health Commercial |
$5,053.24
|
| Rate for Payer: Humana Commercial |
$4,521.32
|
| Rate for Payer: Humana KY Medicaid |
$1,829.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,847.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,865.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,989.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.95
|
| Rate for Payer: PHCS Commercial |
$5,106.43
|
| Rate for Payer: United Healthcare All Payer |
$4,680.90
|
|
|
HEAD V40 TAPER LFIT 32MM -4
|
Facility
|
IP
|
$5,319.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.50 |
| Max. Negotiated Rate |
$5,106.43 |
| Rate for Payer: Aetna Commercial |
$4,095.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.98
|
| Rate for Payer: Cash Price |
$2,659.60
|
| Rate for Payer: Cigna Commercial |
$4,414.94
|
| Rate for Payer: First Health Commercial |
$5,053.24
|
| Rate for Payer: Humana Commercial |
$4,521.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,989.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.95
|
| Rate for Payer: PHCS Commercial |
$5,106.43
|
| Rate for Payer: United Healthcare All Payer |
$4,680.90
|
|
|
HEAD V40 TAPER LFIT 32MM +8
|
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
|
|
