|
HEAD V40 TAPER LFIT 32MM +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 32MM +4
|
Facility
|
OP
|
$5,342.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.60 |
| Max. Negotiated Rate |
$5,128.32 |
| Rate for Payer: Aetna Commercial |
$4,113.34
|
| Rate for Payer: Anthem Medicaid |
$1,837.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,166.76
|
| Rate for Payer: Cash Price |
$2,671.00
|
| Rate for Payer: Cigna Commercial |
$4,433.86
|
| Rate for Payer: First Health Commercial |
$5,074.90
|
| Rate for Payer: Humana Commercial |
$4,540.70
|
| Rate for Payer: Humana KY Medicaid |
$1,837.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,855.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,380.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,942.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,873.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,700.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,006.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,647.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,685.98
|
| Rate for Payer: PHCS Commercial |
$5,128.32
|
| Rate for Payer: United Healthcare All Payer |
$4,700.96
|
|
|
HEAD V40 TAPER LFIT 32MM +4
|
Facility
|
IP
|
$5,342.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.60 |
| Max. Negotiated Rate |
$5,128.32 |
| Rate for Payer: Aetna Commercial |
$4,113.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,166.76
|
| Rate for Payer: Cash Price |
$2,671.00
|
| Rate for Payer: Cigna Commercial |
$4,433.86
|
| Rate for Payer: First Health Commercial |
$5,074.90
|
| Rate for Payer: Humana Commercial |
$4,540.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,380.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,942.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,700.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,006.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,647.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,685.98
|
| Rate for Payer: PHCS Commercial |
$5,128.32
|
| Rate for Payer: United Healthcare All Payer |
$4,700.96
|
|
|
HEAD V40 TAPER LFIT 32MM -4
|
Facility
|
IP
|
$5,342.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.60 |
| Max. Negotiated Rate |
$5,128.32 |
| Rate for Payer: Aetna Commercial |
$4,113.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,166.76
|
| Rate for Payer: Cash Price |
$2,671.00
|
| Rate for Payer: Cigna Commercial |
$4,433.86
|
| Rate for Payer: First Health Commercial |
$5,074.90
|
| Rate for Payer: Humana Commercial |
$4,540.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,380.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,942.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,700.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,006.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,647.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,685.98
|
| Rate for Payer: PHCS Commercial |
$5,128.32
|
| Rate for Payer: United Healthcare All Payer |
$4,700.96
|
|
|
HEAD V40 TAPER LFIT 32MM -4
|
Facility
|
OP
|
$5,342.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,602.60 |
| Max. Negotiated Rate |
$5,128.32 |
| Rate for Payer: Aetna Commercial |
$4,113.34
|
| Rate for Payer: Anthem Medicaid |
$1,837.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,166.76
|
| Rate for Payer: Cash Price |
$2,671.00
|
| Rate for Payer: Cigna Commercial |
$4,433.86
|
| Rate for Payer: First Health Commercial |
$5,074.90
|
| Rate for Payer: Humana Commercial |
$4,540.70
|
| Rate for Payer: Humana KY Medicaid |
$1,837.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,855.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,380.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,942.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,602.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,873.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,700.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,006.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,647.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,685.98
|
| Rate for Payer: PHCS Commercial |
$5,128.32
|
| Rate for Payer: United Healthcare All Payer |
$4,700.96
|
|
|
HEAD V40 TAPER LFIT 32MM +8
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD V40 TAPER LFIT 32MM +8
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD V40 TPR LFIT ANA 36MM +0
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD V40 TPR LFIT ANA 36MM +0
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD V40 TPR LFIT ANA 36MM +5
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD V40 TPR LFIT ANA 36MM +5
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
HEAD V40 TPR LFIT ANA 36MM -5
|
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 TPR LFIT ANA 36MM -5
|
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 TPR LFIT ANA 40MM +0
|
Facility
|
IP
|
$9,183.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,754.93 |
| Max. Negotiated Rate |
$8,815.78 |
| Rate for Payer: Aetna Commercial |
$7,070.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,162.82
|
| Rate for Payer: Cash Price |
$4,591.55
|
| Rate for Payer: Cigna Commercial |
$7,621.97
|
| Rate for Payer: First Health Commercial |
$8,723.94
|
| Rate for Payer: Humana Commercial |
$7,805.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,530.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,777.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,081.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,887.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,346.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,989.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,336.34
|
| Rate for Payer: PHCS Commercial |
$8,815.78
|
| Rate for Payer: United Healthcare All Payer |
$8,081.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM +0
|
Facility
|
OP
|
$9,183.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,754.93 |
| Max. Negotiated Rate |
$8,815.78 |
| Rate for Payer: Aetna Commercial |
$7,070.99
|
| Rate for Payer: Anthem Medicaid |
$3,158.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,162.82
|
| Rate for Payer: Cash Price |
$4,591.55
|
| Rate for Payer: Cigna Commercial |
$7,621.97
|
| Rate for Payer: First Health Commercial |
$8,723.94
|
| Rate for Payer: Humana Commercial |
$7,805.64
|
| Rate for Payer: Humana KY Medicaid |
$3,158.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,190.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,530.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,777.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,221.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,081.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,887.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,346.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,989.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,336.34
|
| Rate for Payer: PHCS Commercial |
$8,815.78
|
| Rate for Payer: United Healthcare All Payer |
$8,081.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM +12
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
HEAD V40 TPR LFIT ANA 40MM +12
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
HEAD V40 TPR LFIT ANA 40MM +4
|
Facility
|
IP
|
$9,184.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.37 |
| Max. Negotiated Rate |
$8,817.18 |
| Rate for Payer: Aetna Commercial |
$7,072.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,163.96
|
| Rate for Payer: Cash Price |
$4,592.28
|
| Rate for Payer: Cigna Commercial |
$7,623.18
|
| Rate for Payer: First Health Commercial |
$8,725.33
|
| Rate for Payer: Humana Commercial |
$7,806.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,531.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,778.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,082.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,888.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,990.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,337.35
|
| Rate for Payer: PHCS Commercial |
$8,817.18
|
| Rate for Payer: United Healthcare All Payer |
$8,082.41
|
|
|
HEAD V40 TPR LFIT ANA 40MM +4
|
Facility
|
OP
|
$9,184.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.37 |
| Max. Negotiated Rate |
$8,817.18 |
| Rate for Payer: Aetna Commercial |
$7,072.11
|
| Rate for Payer: Anthem Medicaid |
$3,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,163.96
|
| Rate for Payer: Cash Price |
$4,592.28
|
| Rate for Payer: Cigna Commercial |
$7,623.18
|
| Rate for Payer: First Health Commercial |
$8,725.33
|
| Rate for Payer: Humana Commercial |
$7,806.88
|
| Rate for Payer: Humana KY Medicaid |
$3,158.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,190.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,531.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,778.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,755.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,221.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,082.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,888.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,990.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,337.35
|
| Rate for Payer: PHCS Commercial |
$8,817.18
|
| Rate for Payer: United Healthcare All Payer |
$8,082.41
|
|
|
HEAD V40 TPR LFIT ANA 40MM -4
|
Facility
|
OP
|
$9,183.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,754.93 |
| Max. Negotiated Rate |
$8,815.78 |
| Rate for Payer: Aetna Commercial |
$7,070.99
|
| Rate for Payer: Anthem Medicaid |
$3,158.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,162.82
|
| Rate for Payer: Cash Price |
$4,591.55
|
| Rate for Payer: Cigna Commercial |
$7,621.97
|
| Rate for Payer: First Health Commercial |
$8,723.94
|
| Rate for Payer: Humana Commercial |
$7,805.64
|
| Rate for Payer: Humana KY Medicaid |
$3,158.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,190.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,530.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,777.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,221.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,081.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,887.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,346.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,989.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,336.34
|
| Rate for Payer: PHCS Commercial |
$8,815.78
|
| Rate for Payer: United Healthcare All Payer |
$8,081.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM -4
|
Facility
|
IP
|
$9,183.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,754.93 |
| Max. Negotiated Rate |
$8,815.78 |
| Rate for Payer: Aetna Commercial |
$7,070.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,162.82
|
| Rate for Payer: Cash Price |
$4,591.55
|
| Rate for Payer: Cigna Commercial |
$7,621.97
|
| Rate for Payer: First Health Commercial |
$8,723.94
|
| Rate for Payer: Humana Commercial |
$7,805.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,530.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,777.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,754.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,081.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,887.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,346.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,989.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,336.34
|
| Rate for Payer: PHCS Commercial |
$8,815.78
|
| Rate for Payer: United Healthcare All Payer |
$8,081.13
|
|
|
HEAD V40 TPR LFIT ANA 40MM +8
|
Facility
|
IP
|
$9,184.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.37 |
| Max. Negotiated Rate |
$8,817.18 |
| Rate for Payer: Aetna Commercial |
$7,072.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,163.96
|
| Rate for Payer: Cash Price |
$4,592.28
|
| Rate for Payer: Cigna Commercial |
$7,623.18
|
| Rate for Payer: First Health Commercial |
$8,725.33
|
| Rate for Payer: Humana Commercial |
$7,806.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,531.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,778.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,755.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,082.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,888.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,990.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,337.35
|
| Rate for Payer: PHCS Commercial |
$8,817.18
|
| Rate for Payer: United Healthcare All Payer |
$8,082.41
|
|
|
HEAD V40 TPR LFIT ANA 40MM +8
|
Facility
|
OP
|
$9,184.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,755.37 |
| Max. Negotiated Rate |
$8,817.18 |
| Rate for Payer: Aetna Commercial |
$7,072.11
|
| Rate for Payer: Anthem Medicaid |
$3,158.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,163.96
|
| Rate for Payer: Cash Price |
$4,592.28
|
| Rate for Payer: Cigna Commercial |
$7,623.18
|
| Rate for Payer: First Health Commercial |
$8,725.33
|
| Rate for Payer: Humana Commercial |
$7,806.88
|
| Rate for Payer: Humana KY Medicaid |
$3,158.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,190.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,531.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,778.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,755.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,221.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,082.41
|
| Rate for Payer: Ohio Health Group HMO |
$6,888.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,990.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,337.35
|
| Rate for Payer: PHCS Commercial |
$8,817.18
|
| Rate for Payer: United Healthcare All Payer |
$8,082.41
|
|
|
HEAD V40 TPR LFIT ANA 44MM +0
|
Facility
|
IP
|
$8,714.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.33 |
| Max. Negotiated Rate |
$8,365.86 |
| Rate for Payer: Aetna Commercial |
$6,710.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,797.26
|
| Rate for Payer: Cash Price |
$4,357.22
|
| Rate for Payer: Cigna Commercial |
$7,232.99
|
| Rate for Payer: First Health Commercial |
$8,278.72
|
| Rate for Payer: Humana Commercial |
$7,407.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,145.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,431.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,668.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,535.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,971.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,581.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,012.96
|
| Rate for Payer: PHCS Commercial |
$8,365.86
|
| Rate for Payer: United Healthcare All Payer |
$7,668.71
|
|
|
HEAD V40 TPR LFIT ANA 44MM +0
|
Facility
|
OP
|
$8,714.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.33 |
| Max. Negotiated Rate |
$8,365.86 |
| Rate for Payer: Aetna Commercial |
$6,710.12
|
| Rate for Payer: Anthem Medicaid |
$2,996.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,797.26
|
| Rate for Payer: Cash Price |
$4,357.22
|
| Rate for Payer: Cigna Commercial |
$7,232.99
|
| Rate for Payer: First Health Commercial |
$8,278.72
|
| Rate for Payer: Humana Commercial |
$7,407.27
|
| Rate for Payer: Humana KY Medicaid |
$2,996.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,145.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,431.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,057.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,668.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,535.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,971.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,581.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,012.96
|
| Rate for Payer: PHCS Commercial |
$8,365.86
|
| Rate for Payer: United Healthcare All Payer |
$7,668.71
|
|
