|
HEAD OXINIUM FEM 40MM
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
HEAD OXINIUM FEM 40MM
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
HEAD OXINIUM MOD 44MM
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
HEAD OXINIUM MOD 44MM
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
HEAD RADIAL RHEAD LATERAL SZ 3
|
Facility
|
OP
|
$13,911.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,173.54 |
| Max. Negotiated Rate |
$13,355.32 |
| Rate for Payer: Aetna Commercial |
$10,712.08
|
| Rate for Payer: Anthem Medicaid |
$4,784.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,851.20
|
| Rate for Payer: Cash Price |
$6,955.90
|
| Rate for Payer: Cigna Commercial |
$11,546.79
|
| Rate for Payer: First Health Commercial |
$13,216.20
|
| Rate for Payer: Humana Commercial |
$11,825.02
|
| Rate for Payer: Humana KY Medicaid |
$4,784.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,832.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,407.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,266.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,173.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,880.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,242.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,433.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,129.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,103.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,599.14
|
| Rate for Payer: PHCS Commercial |
$13,355.32
|
| Rate for Payer: United Healthcare All Payer |
$12,242.38
|
|
|
HEAD RADIAL RHEAD LATERAL SZ 3
|
Facility
|
IP
|
$13,911.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,173.54 |
| Max. Negotiated Rate |
$13,355.32 |
| Rate for Payer: Aetna Commercial |
$10,712.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,851.20
|
| Rate for Payer: Cash Price |
$6,955.90
|
| Rate for Payer: Cigna Commercial |
$11,546.79
|
| Rate for Payer: First Health Commercial |
$13,216.20
|
| Rate for Payer: Humana Commercial |
$11,825.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,407.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,266.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,173.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,242.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,433.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,129.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,103.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,599.14
|
| Rate for Payer: PHCS Commercial |
$13,355.32
|
| Rate for Payer: United Healthcare All Payer |
$12,242.38
|
|
|
HEAD RINGLOC BI-POLAR 28*41MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*41MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*43MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*43MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*47MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*47MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*48MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*48MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*53MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*53MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*54MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*54MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*55MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*55MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*56MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*56MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*57MM
|
Facility
|
OP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem Medicaid |
$2,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Humana KY Medicaid |
$2,688.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,715.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*57MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
|
HEAD RINGLOC BI-POLAR 28*58MM
|
Facility
|
IP
|
$7,818.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.40 |
| Max. Negotiated Rate |
$7,505.28 |
| Rate for Payer: Aetna Commercial |
$6,019.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.04
|
| Rate for Payer: Cash Price |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$6,488.94
|
| Rate for Payer: First Health Commercial |
$7,427.10
|
| Rate for Payer: Humana Commercial |
$6,645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,410.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,769.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,879.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,801.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.42
|
| Rate for Payer: PHCS Commercial |
$7,505.28
|
| Rate for Payer: United Healthcare All Payer |
$6,879.84
|
|
