|
ALUMINA HEAD 32MM V40 +5
|
Facility
|
OP
|
$7,457.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.46 |
| Max. Negotiated Rate |
$7,159.10 |
| Rate for Payer: Aetna Commercial |
$5,742.20
|
| Rate for Payer: Anthem Medicaid |
$2,564.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,816.77
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$6,189.64
|
| Rate for Payer: First Health Commercial |
$7,084.53
|
| Rate for Payer: Humana Commercial |
$6,338.79
|
| Rate for Payer: Humana KY Medicaid |
$2,564.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,590.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,115.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,503.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,616.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,562.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,593.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.79
|
| Rate for Payer: PHCS Commercial |
$7,159.10
|
| Rate for Payer: United Healthcare All Payer |
$6,562.51
|
|
|
ALUMINA HEAD 32MM V40 -5
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
ALUMINA HEAD 32MM V40 -5
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
ALUMINA HEAD 36MM V40 0
|
Facility
|
OP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
ALUMINA HEAD 36MM V40 0
|
Facility
|
IP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
ALUMINA HEAD 36MM V40 +5
|
Facility
|
IP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
ALUMINA HEAD 36MM V40 +5
|
Facility
|
OP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
ALUMINA HEAD 36MM V40 -5
|
Facility
|
OP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
ALUMINA HEAD 36MM V40 -5
|
Facility
|
IP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
ALUMINA V40 FEM HEAD +0 28MM
|
Facility
|
IP
|
$8,207.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.02 |
| Max. Negotiated Rate |
$7,879.53 |
| Rate for Payer: Aetna Commercial |
$6,320.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,402.12
|
| Rate for Payer: Cash Price |
$4,103.92
|
| Rate for Payer: Cigna Commercial |
$6,812.51
|
| Rate for Payer: First Health Commercial |
$7,797.45
|
| Rate for Payer: Humana Commercial |
$6,976.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,730.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,057.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,462.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,222.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,155.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,067.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.43
|
| Rate for Payer: PHCS Commercial |
$7,879.53
|
| Rate for Payer: United Healthcare All Payer |
$7,222.90
|
|
|
ALUMINA V40 FEM HEAD +0 28MM
|
Facility
|
OP
|
$8,207.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.02 |
| Max. Negotiated Rate |
$7,879.53 |
| Rate for Payer: Aetna Commercial |
$6,320.04
|
| Rate for Payer: Anthem Medicaid |
$2,822.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,402.12
|
| Rate for Payer: Cash Price |
$4,103.92
|
| Rate for Payer: Cigna Commercial |
$6,812.51
|
| Rate for Payer: First Health Commercial |
$7,797.45
|
| Rate for Payer: Humana Commercial |
$6,976.66
|
| Rate for Payer: Humana KY Medicaid |
$2,822.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,851.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,730.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,057.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,462.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,879.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,222.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,155.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,641.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,067.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.43
|
| Rate for Payer: PHCS Commercial |
$7,879.53
|
| Rate for Payer: United Healthcare All Payer |
$7,222.90
|
|
|
ALUMINA V40 FEM HEAD +0 32MM
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
ALUMINA V40 FEM HEAD +0 32MM
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
ALUMINA V40 FEM HEAD +0 36MM
|
Facility
|
OP
|
$9,115.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.07 |
| Max. Negotiated Rate |
$8,751.32 |
| Rate for Payer: Aetna Commercial |
$7,019.29
|
| Rate for Payer: Anthem Medicaid |
$3,134.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,110.45
|
| Rate for Payer: Cash Price |
$4,557.98
|
| Rate for Payer: Cigna Commercial |
$7,566.25
|
| Rate for Payer: First Health Commercial |
$8,660.16
|
| Rate for Payer: Humana Commercial |
$7,748.57
|
| Rate for Payer: Humana KY Medicaid |
$3,134.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,475.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,727.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,197.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,022.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,836.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,823.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,825.95
|
| Rate for Payer: PHCS Commercial |
$8,751.32
|
| Rate for Payer: United Healthcare All Payer |
$8,022.04
|
|
|
ALUMINA V40 FEM HEAD +0 36MM
|
Facility
|
IP
|
$9,115.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.07 |
| Max. Negotiated Rate |
$8,751.32 |
| Rate for Payer: Aetna Commercial |
$7,019.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,110.45
|
| Rate for Payer: Cash Price |
$4,557.98
|
| Rate for Payer: Cigna Commercial |
$7,566.25
|
| Rate for Payer: First Health Commercial |
$8,660.16
|
| Rate for Payer: Humana Commercial |
$7,748.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,475.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,727.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,022.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,836.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,823.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,825.95
|
| Rate for Payer: PHCS Commercial |
$8,751.32
|
| Rate for Payer: United Healthcare All Payer |
$8,022.04
|
|
|
ALUMINA V40 FEM HEAD-2.7 28MM
|
Facility
|
IP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
ALUMINA V40 FEM HEAD-2.7 28MM
|
Facility
|
OP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem Medicaid |
$2,768.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Humana KY Medicaid |
$2,768.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,796.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
ALUMINA V40 FEM HEAD +4 28MM
|
Facility
|
IP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
ALUMINA V40 FEM HEAD +4 28MM
|
Facility
|
OP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem Medicaid |
$2,768.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Humana KY Medicaid |
$2,768.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,796.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
ALUMINA V40 FEM HEAD +4 32MM
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
ALUMINA V40 FEM HEAD +4 32MM
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
ALUMINA V40 FEM HEAD -4 32MM
|
Facility
|
OP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem Medicaid |
$2,768.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Humana KY Medicaid |
$2,768.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,796.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,824.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
ALUMINA V40 FEM HEAD -4 32MM
|
Facility
|
IP
|
$8,050.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.52 |
| Max. Negotiated Rate |
$7,728.15 |
| Rate for Payer: Aetna Commercial |
$6,198.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,279.12
|
| Rate for Payer: Cash Price |
$4,025.08
|
| Rate for Payer: Cigna Commercial |
$6,681.63
|
| Rate for Payer: First Health Commercial |
$7,647.65
|
| Rate for Payer: Humana Commercial |
$6,842.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,601.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,941.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,415.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,084.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,037.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,610.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.55
|
| Rate for Payer: PHCS Commercial |
$7,728.15
|
| Rate for Payer: United Healthcare All Payer |
$7,084.14
|
|
|
ALUMINA V40 FEM HEAD +5 36MM
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
ALUMINA V40 FEM HEAD +5 36MM
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
