|
MOD HEAD 2MM HEMI HEAD 40MM
|
Facility
|
IP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
MOD HEAD 2MM HEMI HEAD 44MM
|
Facility
|
IP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
MOD HEAD 2MM HEMI HEAD 44MM
|
Facility
|
OP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem Medicaid |
$5,487.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Humana KY Medicaid |
$5,487.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,543.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,598.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
MOD HEAD 2MM HEMI HEAD 48MM
|
Facility
|
OP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem Medicaid |
$5,487.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Humana KY Medicaid |
$5,487.91
|
| Rate for Payer: Kentucky WC Medicaid |
$5,543.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,598.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
MOD HEAD 2MM HEMI HEAD 48MM
|
Facility
|
IP
|
$15,957.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,787.36 |
| Max. Negotiated Rate |
$15,319.56 |
| Rate for Payer: Aetna Commercial |
$12,287.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,447.15
|
| Rate for Payer: Cash Price |
$7,978.94
|
| Rate for Payer: Cigna Commercial |
$13,245.04
|
| Rate for Payer: First Health Commercial |
$15,159.99
|
| Rate for Payer: Humana Commercial |
$13,564.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,085.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,776.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,787.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,042.93
|
| Rate for Payer: Ohio Health Group HMO |
$11,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,766.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,883.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,010.94
|
| Rate for Payer: PHCS Commercial |
$15,319.56
|
| Rate for Payer: United Healthcare All Payer |
$14,042.93
|
|
|
MOD HEAD 2MM HEMI HEAD 52MM
|
Facility
|
IP
|
$18,423.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,526.90 |
| Max. Negotiated Rate |
$17,686.08 |
| Rate for Payer: Aetna Commercial |
$14,185.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,369.94
|
| Rate for Payer: Cash Price |
$9,211.50
|
| Rate for Payer: Cigna Commercial |
$15,291.09
|
| Rate for Payer: First Health Commercial |
$17,501.85
|
| Rate for Payer: Humana Commercial |
$15,659.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,106.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,596.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,526.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,212.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,028.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,711.87
|
| Rate for Payer: PHCS Commercial |
$17,686.08
|
| Rate for Payer: United Healthcare All Payer |
$16,212.24
|
|
|
MOD HEAD 2MM HEMI HEAD 52MM
|
Facility
|
OP
|
$18,423.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,526.90 |
| Max. Negotiated Rate |
$17,686.08 |
| Rate for Payer: Aetna Commercial |
$14,185.71
|
| Rate for Payer: Anthem Medicaid |
$6,335.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,369.94
|
| Rate for Payer: Cash Price |
$9,211.50
|
| Rate for Payer: Cigna Commercial |
$15,291.09
|
| Rate for Payer: First Health Commercial |
$17,501.85
|
| Rate for Payer: Humana Commercial |
$15,659.55
|
| Rate for Payer: Humana KY Medicaid |
$6,335.67
|
| Rate for Payer: Kentucky WC Medicaid |
$6,400.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,106.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,596.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,526.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,462.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,212.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,028.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,711.87
|
| Rate for Payer: PHCS Commercial |
$17,686.08
|
| Rate for Payer: United Healthcare All Payer |
$16,212.24
|
|
|
MOD HEAD 2MM HEMI HEAD 56MM
|
Facility
|
IP
|
$18,423.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,526.90 |
| Max. Negotiated Rate |
$17,686.08 |
| Rate for Payer: Aetna Commercial |
$14,185.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,369.94
|
| Rate for Payer: Cash Price |
$9,211.50
|
| Rate for Payer: Cigna Commercial |
$15,291.09
|
| Rate for Payer: First Health Commercial |
$17,501.85
|
| Rate for Payer: Humana Commercial |
$15,659.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,106.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,596.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,526.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,212.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,028.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,711.87
|
| Rate for Payer: PHCS Commercial |
$17,686.08
|
| Rate for Payer: United Healthcare All Payer |
$16,212.24
|
|
|
MOD HEAD 2MM HEMI HEAD 56MM
|
Facility
|
OP
|
$18,423.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,526.90 |
| Max. Negotiated Rate |
$17,686.08 |
| Rate for Payer: Aetna Commercial |
$14,185.71
|
| Rate for Payer: Anthem Medicaid |
$6,335.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,369.94
|
| Rate for Payer: Cash Price |
$9,211.50
|
| Rate for Payer: Cigna Commercial |
$15,291.09
|
| Rate for Payer: First Health Commercial |
$17,501.85
|
| Rate for Payer: Humana Commercial |
$15,659.55
|
| Rate for Payer: Humana KY Medicaid |
$6,335.67
|
| Rate for Payer: Kentucky WC Medicaid |
$6,400.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,106.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,596.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,526.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,462.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,212.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,817.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,738.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,028.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,711.87
|
| Rate for Payer: PHCS Commercial |
$17,686.08
|
| Rate for Payer: United Healthcare All Payer |
$16,212.24
|
|
|
MOD HEAD COMP 28MM +12
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
MOD HEAD COMP 28MM +12
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
MOD HEAD COMP 28MM +3
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
MOD HEAD COMP 28MM +3
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
MOD HEAD COMP 28MM -3
|
Facility
|
IP
|
$4,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.25 |
| Max. Negotiated Rate |
$4,490.40 |
| Rate for Payer: Aetna Commercial |
$3,601.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.45
|
| Rate for Payer: Cash Price |
$2,338.75
|
| Rate for Payer: Cigna Commercial |
$3,882.32
|
| Rate for Payer: First Health Commercial |
$4,443.62
|
| Rate for Payer: Humana Commercial |
$3,975.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,742.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,069.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,227.47
|
| Rate for Payer: PHCS Commercial |
$4,490.40
|
| Rate for Payer: United Healthcare All Payer |
$4,116.20
|
|
|
MOD HEAD COMP 28MM -3
|
Facility
|
OP
|
$4,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.25 |
| Max. Negotiated Rate |
$4,490.40 |
| Rate for Payer: Aetna Commercial |
$3,601.68
|
| Rate for Payer: Anthem Medicaid |
$1,608.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.45
|
| Rate for Payer: Cash Price |
$2,338.75
|
| Rate for Payer: Cigna Commercial |
$3,882.32
|
| Rate for Payer: First Health Commercial |
$4,443.62
|
| Rate for Payer: Humana Commercial |
$3,975.88
|
| Rate for Payer: Humana KY Medicaid |
$1,608.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,624.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,640.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,742.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,069.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,227.47
|
| Rate for Payer: PHCS Commercial |
$4,490.40
|
| Rate for Payer: United Healthcare All Payer |
$4,116.20
|
|
|
MOD HEAD COMP 28MM +9
|
Facility
|
IP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 28MM +9
|
Facility
|
OP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem Medicaid |
$1,540.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Humana KY Medicaid |
$1,540.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,555.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,571.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 28MM STD
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
MOD HEAD COMP 28MM STD
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
MOD HEAD COMP 32MM -3
|
Facility
|
IP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 32MM -3
|
Facility
|
OP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem Medicaid |
$1,540.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Humana KY Medicaid |
$1,540.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,555.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,571.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 32MM -6
|
Facility
|
IP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 32MM -6
|
Facility
|
OP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem Medicaid |
$1,540.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Humana KY Medicaid |
$1,540.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,555.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,571.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 32MM STD
|
Facility
|
OP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem Medicaid |
$1,540.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Humana KY Medicaid |
$1,540.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,555.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,571.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
|
MOD HEAD COMP 32MM STD
|
Facility
|
IP
|
$4,478.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,299.60 |
| Rate for Payer: Aetna Commercial |
$3,448.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,493.43
|
| Rate for Payer: Cash Price |
$2,239.38
|
| Rate for Payer: Cigna Commercial |
$3,717.36
|
| Rate for Payer: First Health Commercial |
$4,254.81
|
| Rate for Payer: Humana Commercial |
$3,806.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,672.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,305.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,343.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,941.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,359.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,583.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,896.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,090.34
|
| Rate for Payer: PHCS Commercial |
$4,299.60
|
| Rate for Payer: United Healthcare All Payer |
$3,941.30
|
|
