|
ALUMINA V40 FEM HEAD +0 28MM
|
Facility
|
OP
|
$8,407.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.35 |
| Max. Negotiated Rate |
$8,071.53 |
| Rate for Payer: Aetna Commercial |
$6,474.04
|
| Rate for Payer: Anthem Medicaid |
$2,891.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,558.12
|
| Rate for Payer: Cash Price |
$4,203.92
|
| Rate for Payer: Cigna Commercial |
$6,978.51
|
| Rate for Payer: First Health Commercial |
$7,987.45
|
| Rate for Payer: Humana Commercial |
$7,146.66
|
| Rate for Payer: Humana KY Medicaid |
$2,891.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,920.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,894.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,204.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,522.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,949.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,398.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,305.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,726.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,314.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,801.41
|
| Rate for Payer: PHCS Commercial |
$8,071.53
|
| Rate for Payer: United Healthcare All Payer |
$7,398.90
|
|
|
ALUMINA V40 FEM HEAD +0 28MM
|
Facility
|
IP
|
$8,407.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.35 |
| Max. Negotiated Rate |
$8,071.53 |
| Rate for Payer: Aetna Commercial |
$6,474.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,558.12
|
| Rate for Payer: Cash Price |
$4,203.92
|
| Rate for Payer: Cigna Commercial |
$6,978.51
|
| Rate for Payer: First Health Commercial |
$7,987.45
|
| Rate for Payer: Humana Commercial |
$7,146.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,894.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,204.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,522.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,398.90
|
| Rate for Payer: Ohio Health Group HMO |
$6,305.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,726.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,314.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,801.41
|
| Rate for Payer: PHCS Commercial |
$8,071.53
|
| Rate for Payer: United Healthcare All Payer |
$7,398.90
|
|
|
ALUMINA V40 FEM HEAD +0 32MM
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
ALUMINA V40 FEM HEAD +0 32MM
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
ALUMINA V40 FEM HEAD +0 36MM
|
Facility
|
OP
|
$9,315.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.79 |
| Max. Negotiated Rate |
$8,943.32 |
| Rate for Payer: Aetna Commercial |
$7,173.29
|
| Rate for Payer: Anthem Medicaid |
$3,203.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,266.45
|
| Rate for Payer: Cash Price |
$4,657.98
|
| Rate for Payer: Cigna Commercial |
$7,732.25
|
| Rate for Payer: First Health Commercial |
$8,850.16
|
| Rate for Payer: Humana Commercial |
$7,918.57
|
| Rate for Payer: Humana KY Medicaid |
$3,203.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,639.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,875.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,268.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,198.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,452.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,104.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,428.01
|
| Rate for Payer: PHCS Commercial |
$8,943.32
|
| Rate for Payer: United Healthcare All Payer |
$8,198.04
|
|
|
ALUMINA V40 FEM HEAD +0 36MM
|
Facility
|
IP
|
$9,315.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.79 |
| Max. Negotiated Rate |
$8,943.32 |
| Rate for Payer: Aetna Commercial |
$7,173.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,266.45
|
| Rate for Payer: Cash Price |
$4,657.98
|
| Rate for Payer: Cigna Commercial |
$7,732.25
|
| Rate for Payer: First Health Commercial |
$8,850.16
|
| Rate for Payer: Humana Commercial |
$7,918.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,639.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,875.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,198.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,452.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,104.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,428.01
|
| Rate for Payer: PHCS Commercial |
$8,943.32
|
| Rate for Payer: United Healthcare All Payer |
$8,198.04
|
|
|
ALUMINA V40 FEM HEAD-2.7 28MM
|
Facility
|
IP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
ALUMINA V40 FEM HEAD-2.7 28MM
|
Facility
|
OP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem Medicaid |
$2,837.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Humana KY Medicaid |
$2,837.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,866.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,894.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
ALUMINA V40 FEM HEAD +4 28MM
|
Facility
|
OP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem Medicaid |
$2,837.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Humana KY Medicaid |
$2,837.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,866.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,894.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
ALUMINA V40 FEM HEAD +4 28MM
|
Facility
|
IP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
ALUMINA V40 FEM HEAD +4 32MM
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
ALUMINA V40 FEM HEAD +4 32MM
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
ALUMINA V40 FEM HEAD -4 32MM
|
Facility
|
OP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem Medicaid |
$2,837.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Humana KY Medicaid |
$2,837.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,866.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,894.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
ALUMINA V40 FEM HEAD -4 32MM
|
Facility
|
IP
|
$8,250.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,475.05 |
| Max. Negotiated Rate |
$7,920.15 |
| Rate for Payer: Aetna Commercial |
$6,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,435.12
|
| Rate for Payer: Cash Price |
$4,125.08
|
| Rate for Payer: Cigna Commercial |
$6,847.63
|
| Rate for Payer: First Health Commercial |
$7,837.65
|
| Rate for Payer: Humana Commercial |
$7,012.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,765.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,088.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,260.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,187.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,600.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,177.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,692.61
|
| Rate for Payer: PHCS Commercial |
$7,920.15
|
| Rate for Payer: United Healthcare All Payer |
$7,260.14
|
|
|
ALUMINA V40 FEM HEAD +5 36MM
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
ALUMINA V40 FEM HEAD +5 36MM
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
ALUMINA V40 FEM HEAD -5 36MM
|
Facility
|
OP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem Medicaid |
$3,140.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Humana KY Medicaid |
$3,140.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
ALUMINA V40 FEM HEAD -5 36MM
|
Facility
|
IP
|
$9,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.60 |
| Max. Negotiated Rate |
$8,766.72 |
| Rate for Payer: Aetna Commercial |
$7,031.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.96
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cigna Commercial |
$7,579.56
|
| Rate for Payer: First Health Commercial |
$8,675.40
|
| Rate for Payer: Humana Commercial |
$7,762.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,944.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,301.08
|
| Rate for Payer: PHCS Commercial |
$8,766.72
|
| Rate for Payer: United Healthcare All Payer |
$8,036.16
|
|
|
ALUM US 36MM HD 12/14 TPR +0 S
|
Facility
|
IP
|
$12,014.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,604.32 |
| Max. Negotiated Rate |
$11,533.82 |
| Rate for Payer: Aetna Commercial |
$9,251.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,371.23
|
| Rate for Payer: Cash Price |
$6,007.20
|
| Rate for Payer: Cigna Commercial |
$9,971.95
|
| Rate for Payer: First Health Commercial |
$11,413.68
|
| Rate for Payer: Humana Commercial |
$10,212.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,851.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,866.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,604.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,572.67
|
| Rate for Payer: Ohio Health Group HMO |
$9,010.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,611.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,452.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,289.94
|
| Rate for Payer: PHCS Commercial |
$11,533.82
|
| Rate for Payer: United Healthcare All Payer |
$10,572.67
|
|
|
ALUM US 36MM HD 12/14 TPR +0 S
|
Facility
|
OP
|
$12,014.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,604.32 |
| Max. Negotiated Rate |
$11,533.82 |
| Rate for Payer: Aetna Commercial |
$9,251.09
|
| Rate for Payer: Anthem Medicaid |
$4,131.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,371.23
|
| Rate for Payer: Cash Price |
$6,007.20
|
| Rate for Payer: Cigna Commercial |
$9,971.95
|
| Rate for Payer: First Health Commercial |
$11,413.68
|
| Rate for Payer: Humana Commercial |
$10,212.24
|
| Rate for Payer: Humana KY Medicaid |
$4,131.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,851.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,866.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,604.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,214.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,572.67
|
| Rate for Payer: Ohio Health Group HMO |
$9,010.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,611.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,452.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,289.94
|
| Rate for Payer: PHCS Commercial |
$11,533.82
|
| Rate for Payer: United Healthcare All Payer |
$10,572.67
|
|
|
ALUM US 36MM HD 12/14 TPR +4 M
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
ALUM US 36MM HD 12/14 TPR +4 M
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
ALUM US 36MM HD 12/14 TPR +8 L
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
ALUM US 36MM HD 12/14 TPR +8 L
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
ALYMSYS 10mg (100mg SDV)
|
Facility
|
OP
|
$3,916.37
|
|
|
Service Code
|
HCPCS Q5126
|
| Hospital Charge Code |
25004320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$3,759.72 |
| Rate for Payer: Aetna Commercial |
$3,015.60
|
| Rate for Payer: Anthem Medicaid |
$1,346.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.51
|
| Rate for Payer: Cash Price |
$1,958.18
|
| Rate for Payer: Cash Price |
$1,958.18
|
| Rate for Payer: Cigna Commercial |
$3,250.59
|
| Rate for Payer: First Health Commercial |
$3,720.55
|
| Rate for Payer: Humana Commercial |
$3,328.91
|
| Rate for Payer: Humana KY Medicaid |
$1,346.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.30
|
| Rate for Payer: PHCS Commercial |
$3,759.72
|
| Rate for Payer: United Healthcare All Payer |
$3,446.41
|
|
