|
HEAD V40 TAPER LFIT 32MM +8
|
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 TPR LFIT ANA 36MM +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 TPR LFIT ANA 36MM +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 TPR LFIT ANA 36MM +5
|
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 TPR LFIT ANA 36MM +5
|
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 TPR LFIT ANA 36MM -5
|
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 TPR LFIT ANA 36MM -5
|
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 TPR LFIT ANA 40MM +0
|
Facility
|
OP
|
$8,983.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.80 |
| Max. Negotiated Rate |
$8,623.78 |
| Rate for Payer: Aetna Commercial |
$6,916.99
|
| Rate for Payer: Anthem Medicaid |
$3,089.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,006.82
|
| Rate for Payer: Cash Price |
$4,491.55
|
| Rate for Payer: Cigna Commercial |
$7,455.97
|
| Rate for Payer: First Health Commercial |
$8,533.94
|
| Rate for Payer: Humana Commercial |
$7,635.64
|
| Rate for Payer: Humana KY Medicaid |
$3,089.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,120.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,366.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,629.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,694.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,151.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,905.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,737.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.76
|
| Rate for Payer: PHCS Commercial |
$8,623.78
|
| Rate for Payer: United Healthcare All Payer |
$7,905.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM +0
|
Facility
|
IP
|
$8,983.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.80 |
| Max. Negotiated Rate |
$8,623.78 |
| Rate for Payer: Aetna Commercial |
$6,916.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,006.82
|
| Rate for Payer: Cash Price |
$4,491.55
|
| Rate for Payer: Cigna Commercial |
$7,455.97
|
| Rate for Payer: First Health Commercial |
$8,533.94
|
| Rate for Payer: Humana Commercial |
$7,635.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,366.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,629.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,694.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,905.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,737.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.76
|
| Rate for Payer: PHCS Commercial |
$8,623.78
|
| Rate for Payer: United Healthcare All Payer |
$7,905.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM +12
|
Facility
|
IP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD V40 TPR LFIT ANA 40MM +12
|
Facility
|
OP
|
$7,683.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.88 |
| Max. Negotiated Rate |
$7,376.35 |
| Rate for Payer: Aetna Commercial |
$5,916.45
|
| Rate for Payer: Anthem Medicaid |
$2,642.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,993.29
|
| Rate for Payer: Cash Price |
$3,841.85
|
| Rate for Payer: Cigna Commercial |
$6,377.47
|
| Rate for Payer: First Health Commercial |
$7,299.52
|
| Rate for Payer: Humana Commercial |
$6,531.14
|
| Rate for Payer: Humana KY Medicaid |
$2,642.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,300.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,670.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,761.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.95
|
| Rate for Payer: PHCS Commercial |
$7,376.35
|
| Rate for Payer: United Healthcare All Payer |
$6,761.66
|
|
|
HEAD V40 TPR LFIT ANA 40MM +4
|
Facility
|
OP
|
$8,984.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.99 |
| Max. Negotiated Rate |
$8,625.18 |
| Rate for Payer: Aetna Commercial |
$6,918.11
|
| Rate for Payer: Anthem Medicaid |
$3,089.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,007.96
|
| Rate for Payer: Cash Price |
$4,492.28
|
| Rate for Payer: Cigna Commercial |
$7,457.18
|
| Rate for Payer: First Health Commercial |
$8,535.33
|
| Rate for Payer: Humana Commercial |
$7,636.88
|
| Rate for Payer: Humana KY Medicaid |
$3,089.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,367.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,630.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,151.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,906.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,738.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.21
|
| Rate for Payer: PHCS Commercial |
$8,625.18
|
| Rate for Payer: United Healthcare All Payer |
$7,906.41
|
|
|
HEAD V40 TPR LFIT ANA 40MM +4
|
Facility
|
IP
|
$8,984.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.99 |
| Max. Negotiated Rate |
$8,625.18 |
| Rate for Payer: Aetna Commercial |
$6,918.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,007.96
|
| Rate for Payer: Cash Price |
$4,492.28
|
| Rate for Payer: Cigna Commercial |
$7,457.18
|
| Rate for Payer: First Health Commercial |
$8,535.33
|
| Rate for Payer: Humana Commercial |
$7,636.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,367.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,630.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,906.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,738.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.21
|
| Rate for Payer: PHCS Commercial |
$8,625.18
|
| Rate for Payer: United Healthcare All Payer |
$7,906.41
|
|
|
HEAD V40 TPR LFIT ANA 40MM -4
|
Facility
|
IP
|
$8,983.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.80 |
| Max. Negotiated Rate |
$8,623.78 |
| Rate for Payer: Aetna Commercial |
$6,916.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,006.82
|
| Rate for Payer: Cash Price |
$4,491.55
|
| Rate for Payer: Cigna Commercial |
$7,455.97
|
| Rate for Payer: First Health Commercial |
$8,533.94
|
| Rate for Payer: Humana Commercial |
$7,635.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,366.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,629.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,694.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,905.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,737.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.76
|
| Rate for Payer: PHCS Commercial |
$8,623.78
|
| Rate for Payer: United Healthcare All Payer |
$7,905.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM -4
|
Facility
|
OP
|
$8,983.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.80 |
| Max. Negotiated Rate |
$8,623.78 |
| Rate for Payer: Aetna Commercial |
$6,916.99
|
| Rate for Payer: Anthem Medicaid |
$3,089.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,006.82
|
| Rate for Payer: Cash Price |
$4,491.55
|
| Rate for Payer: Cigna Commercial |
$7,455.97
|
| Rate for Payer: First Health Commercial |
$8,533.94
|
| Rate for Payer: Humana Commercial |
$7,635.64
|
| Rate for Payer: Humana KY Medicaid |
$3,089.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,120.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,366.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,629.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,694.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,151.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,905.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,737.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.76
|
| Rate for Payer: PHCS Commercial |
$8,623.78
|
| Rate for Payer: United Healthcare All Payer |
$7,905.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM +8
|
Facility
|
IP
|
$8,984.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.99 |
| Max. Negotiated Rate |
$8,625.18 |
| Rate for Payer: Aetna Commercial |
$6,918.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,007.96
|
| Rate for Payer: Cash Price |
$4,492.28
|
| Rate for Payer: Cigna Commercial |
$7,457.18
|
| Rate for Payer: First Health Commercial |
$8,535.33
|
| Rate for Payer: Humana Commercial |
$7,636.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,367.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,630.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,906.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,738.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.21
|
| Rate for Payer: PHCS Commercial |
$8,625.18
|
| Rate for Payer: United Healthcare All Payer |
$7,906.41
|
|
|
HEAD V40 TPR LFIT ANA 40MM +8
|
Facility
|
OP
|
$8,984.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.99 |
| Max. Negotiated Rate |
$8,625.18 |
| Rate for Payer: Aetna Commercial |
$6,918.11
|
| Rate for Payer: Anthem Medicaid |
$3,089.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,007.96
|
| Rate for Payer: Cash Price |
$4,492.28
|
| Rate for Payer: Cigna Commercial |
$7,457.18
|
| Rate for Payer: First Health Commercial |
$8,535.33
|
| Rate for Payer: Humana Commercial |
$7,636.88
|
| Rate for Payer: Humana KY Medicaid |
$3,089.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,367.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,630.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,151.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,906.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,738.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.21
|
| Rate for Payer: PHCS Commercial |
$8,625.18
|
| Rate for Payer: United Healthcare All Payer |
$7,906.41
|
|
|
HEAD V40 TPR LFIT ANA 44MM +0
|
Facility
|
IP
|
$8,514.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.88 |
| Max. Negotiated Rate |
$8,173.86 |
| Rate for Payer: Aetna Commercial |
$6,556.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,641.26
|
| Rate for Payer: Cash Price |
$4,257.22
|
| Rate for Payer: Cigna Commercial |
$7,066.99
|
| Rate for Payer: First Health Commercial |
$8,088.72
|
| Rate for Payer: Humana Commercial |
$7,237.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,981.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,283.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,554.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,492.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,385.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,106.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,639.48
|
| Rate for Payer: PHCS Commercial |
$8,173.86
|
| Rate for Payer: United Healthcare All Payer |
$7,492.71
|
|
|
HEAD V40 TPR LFIT ANA 44MM +0
|
Facility
|
OP
|
$8,514.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.88 |
| Max. Negotiated Rate |
$8,173.86 |
| Rate for Payer: Aetna Commercial |
$6,556.12
|
| Rate for Payer: Anthem Medicaid |
$2,928.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,641.26
|
| Rate for Payer: Cash Price |
$4,257.22
|
| Rate for Payer: Cigna Commercial |
$7,066.99
|
| Rate for Payer: First Health Commercial |
$8,088.72
|
| Rate for Payer: Humana Commercial |
$7,237.27
|
| Rate for Payer: Humana KY Medicaid |
$2,928.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,957.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,981.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,283.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,554.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,986.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,492.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,385.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,106.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,639.48
|
| Rate for Payer: PHCS Commercial |
$8,173.86
|
| Rate for Payer: United Healthcare All Payer |
$7,492.71
|
|
|
HEAD V40 TPR LFIT ANA 44MM +4
|
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 TPR LFIT ANA 44MM +4
|
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 TPR LFIT ANA 44MM -4
|
Facility
|
IP
|
$8,984.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.99 |
| Max. Negotiated Rate |
$8,625.18 |
| Rate for Payer: Aetna Commercial |
$6,918.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,007.96
|
| Rate for Payer: Cash Price |
$4,492.28
|
| Rate for Payer: Cigna Commercial |
$7,457.18
|
| Rate for Payer: First Health Commercial |
$8,535.33
|
| Rate for Payer: Humana Commercial |
$7,636.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,367.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,630.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,906.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,738.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.21
|
| Rate for Payer: PHCS Commercial |
$8,625.18
|
| Rate for Payer: United Healthcare All Payer |
$7,906.41
|
|
|
HEAD V40 TPR LFIT ANA 44MM -4
|
Facility
|
OP
|
$8,984.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.99 |
| Max. Negotiated Rate |
$8,625.18 |
| Rate for Payer: Aetna Commercial |
$6,918.11
|
| Rate for Payer: Anthem Medicaid |
$3,089.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,007.96
|
| Rate for Payer: Cash Price |
$4,492.28
|
| Rate for Payer: Cigna Commercial |
$7,457.18
|
| Rate for Payer: First Health Commercial |
$8,535.33
|
| Rate for Payer: Humana Commercial |
$7,636.88
|
| Rate for Payer: Humana KY Medicaid |
$3,089.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,367.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,630.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,151.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,906.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,738.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,796.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,167.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.21
|
| Rate for Payer: PHCS Commercial |
$8,625.18
|
| Rate for Payer: United Healthcare All Payer |
$7,906.41
|
|
|
HEALIX ANCHOR 5.5 BIO ABS.
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.23 |
| Max. Negotiated Rate |
$3,812.16 |
| Rate for Payer: Aetna Commercial |
$3,057.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,097.38
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$3,295.93
|
| Rate for Payer: First Health Commercial |
$3,772.45
|
| Rate for Payer: Humana Commercial |
$3,375.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,256.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,930.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,494.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,978.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.01
|
| Rate for Payer: PHCS Commercial |
$3,812.16
|
| Rate for Payer: United Healthcare All Payer |
$3,494.48
|
|
|
HEALIX ANCHOR 5.5 BIO ABS.
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.23 |
| Max. Negotiated Rate |
$3,812.16 |
| Rate for Payer: Aetna Commercial |
$3,057.67
|
| Rate for Payer: Anthem Medicaid |
$1,365.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,097.38
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$3,295.93
|
| Rate for Payer: First Health Commercial |
$3,772.45
|
| Rate for Payer: Humana Commercial |
$3,375.35
|
| Rate for Payer: Humana KY Medicaid |
$1,365.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,379.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,256.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,930.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,494.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,978.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.01
|
| Rate for Payer: PHCS Commercial |
$3,812.16
|
| Rate for Payer: United Healthcare All Payer |
$3,494.48
|
|
