|
HEAD V40 TAPER LFIT 26MM +16
|
Facility
|
IP
|
$4,550.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna Commercial |
$3,503.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,549.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cigna Commercial |
$3,776.50
|
| Rate for Payer: First Health Commercial |
$4,322.50
|
| Rate for Payer: Humana Commercial |
$3,867.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,731.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,365.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,004.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,958.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,139.50
|
| Rate for Payer: PHCS Commercial |
$4,368.00
|
| Rate for Payer: United Healthcare All Payer |
$4,004.00
|
|
|
HEAD V40 TAPER LFIT 26MM +16
|
Facility
|
OP
|
$4,550.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna Commercial |
$3,503.50
|
| Rate for Payer: Anthem Medicaid |
$1,564.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,549.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cigna Commercial |
$3,776.50
|
| Rate for Payer: First Health Commercial |
$4,322.50
|
| Rate for Payer: Humana Commercial |
$3,867.50
|
| Rate for Payer: Humana KY Medicaid |
$1,564.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,580.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,731.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,365.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,596.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,004.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,958.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,139.50
|
| Rate for Payer: PHCS Commercial |
$4,368.00
|
| Rate for Payer: United Healthcare All Payer |
$4,004.00
|
|
|
HEAD V40 TAPER LFIT 26MM -3
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 26MM -3
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 26MM +4
|
Facility
|
IP
|
$4,488.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.40 |
| Max. Negotiated Rate |
$4,308.49 |
| Rate for Payer: Aetna Commercial |
$3,455.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.65
|
| Rate for Payer: Cash Price |
$2,244.01
|
| Rate for Payer: Cigna Commercial |
$3,725.05
|
| Rate for Payer: First Health Commercial |
$4,263.61
|
| Rate for Payer: Humana Commercial |
$3,814.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,366.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,904.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,096.73
|
| Rate for Payer: PHCS Commercial |
$4,308.49
|
| Rate for Payer: United Healthcare All Payer |
$3,949.45
|
|
|
HEAD V40 TAPER LFIT 26MM +4
|
Facility
|
OP
|
$4,488.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,346.40 |
| Max. Negotiated Rate |
$4,308.49 |
| Rate for Payer: Aetna Commercial |
$3,455.77
|
| Rate for Payer: Anthem Medicaid |
$1,543.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,500.65
|
| Rate for Payer: Cash Price |
$2,244.01
|
| Rate for Payer: Cigna Commercial |
$3,725.05
|
| Rate for Payer: First Health Commercial |
$4,263.61
|
| Rate for Payer: Humana Commercial |
$3,814.81
|
| Rate for Payer: Humana KY Medicaid |
$1,543.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,559.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,346.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,574.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,949.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,366.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,590.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,904.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,096.73
|
| Rate for Payer: PHCS Commercial |
$4,308.49
|
| Rate for Payer: United Healthcare All Payer |
$3,949.45
|
|
|
HEAD V40 TAPER LFIT 26MM +8
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 26MM +8
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +0
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +0
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +12
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +12
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +16
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
HEAD V40 TAPER LFIT 28MM +16
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
HEAD V40 TAPER LFIT 28MM +4
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +4
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM -4
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM -4
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +8
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 28MM +8
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEAD V40 TAPER LFIT 32MM +0
|
Facility
|
IP
|
$4,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.70 |
| Max. Negotiated Rate |
$4,491.84 |
| Rate for Payer: Aetna Commercial |
$3,602.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,649.62
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$3,883.57
|
| Rate for Payer: First Health Commercial |
$4,445.05
|
| Rate for Payer: Humana Commercial |
$3,977.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,836.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,453.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,117.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,509.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,743.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,070.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,228.51
|
| Rate for Payer: PHCS Commercial |
$4,491.84
|
| Rate for Payer: United Healthcare All Payer |
$4,117.52
|
|
|
HEAD V40 TAPER LFIT 32MM +0
|
Facility
|
OP
|
$4,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.70 |
| Max. Negotiated Rate |
$4,491.84 |
| Rate for Payer: Aetna Commercial |
$3,602.83
|
| Rate for Payer: Anthem Medicaid |
$1,609.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,649.62
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$3,883.57
|
| Rate for Payer: First Health Commercial |
$4,445.05
|
| Rate for Payer: Humana Commercial |
$3,977.15
|
| Rate for Payer: Humana KY Medicaid |
$1,609.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,625.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,836.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,453.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,641.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,117.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,509.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,743.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,070.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,228.51
|
| Rate for Payer: PHCS Commercial |
$4,491.84
|
| Rate for Payer: United Healthcare All Payer |
$4,117.52
|
|
|
HEAD V40 TAPER LFIT 32MM +12
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
HEAD V40 TAPER LFIT 32MM +12
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
HEAD V40 TAPER LFIT 32MM +16
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
