|
TAXOTERE 1MG (80MG VIAL)
|
Facility
|
IP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
25002604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.20 |
| Max. Negotiated Rate |
$2,275.92 |
| Rate for Payer: Aetna Commercial |
$1,825.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,849.18
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cigna Commercial |
$1,967.72
|
| Rate for Payer: First Health Commercial |
$2,252.21
|
| Rate for Payer: Humana Commercial |
$2,015.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,944.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,749.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,086.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,778.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.93
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
TAXOTERE 1MG (80MG VIAL)
|
Facility
|
OP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
25002604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.20 |
| Max. Negotiated Rate |
$2,275.92 |
| Rate for Payer: Aetna Commercial |
$1,825.48
|
| Rate for Payer: Anthem Medicaid |
$815.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,849.18
|
| Rate for Payer: Cash Price |
$1,185.38
|
| Rate for Payer: Cigna Commercial |
$1,967.72
|
| Rate for Payer: First Health Commercial |
$2,252.21
|
| Rate for Payer: Humana Commercial |
$2,015.14
|
| Rate for Payer: Humana KY Medicaid |
$815.30
|
| Rate for Payer: Kentucky WC Medicaid |
$823.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,944.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,749.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$831.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,086.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,778.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$474.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.93
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
TBUSHING EXCNGE COMPONENT SM
|
Facility
|
OP
|
$15,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.38 |
| Max. Negotiated Rate |
$14,520.96 |
| Rate for Payer: Aetna Commercial |
$11,647.02
|
| Rate for Payer: Anthem Medicaid |
$5,201.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,798.28
|
| Rate for Payer: Cash Price |
$7,563.00
|
| Rate for Payer: Cigna Commercial |
$12,554.58
|
| Rate for Payer: First Health Commercial |
$14,369.70
|
| Rate for Payer: Humana Commercial |
$12,857.10
|
| Rate for Payer: Humana KY Medicaid |
$5,201.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,254.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,403.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,162.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,537.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,306.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,310.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,344.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.06
|
| Rate for Payer: PHCS Commercial |
$14,520.96
|
| Rate for Payer: United Healthcare All Payer |
$13,310.88
|
|
|
TBUSHING EXCNGE COMPONENT SM
|
Facility
|
IP
|
$15,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.38 |
| Max. Negotiated Rate |
$14,520.96 |
| Rate for Payer: Aetna Commercial |
$11,647.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,798.28
|
| Rate for Payer: Cash Price |
$7,563.00
|
| Rate for Payer: Cigna Commercial |
$12,554.58
|
| Rate for Payer: First Health Commercial |
$14,369.70
|
| Rate for Payer: Humana Commercial |
$12,857.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,403.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,162.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,537.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,310.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,344.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.06
|
| Rate for Payer: PHCS Commercial |
$14,520.96
|
| Rate for Payer: United Healthcare All Payer |
$13,310.88
|
|
|
TBUSHNG EXCHNGE COMPNENT X-SM
|
Facility
|
OP
|
$15,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.38 |
| Max. Negotiated Rate |
$14,520.96 |
| Rate for Payer: Aetna Commercial |
$11,647.02
|
| Rate for Payer: Anthem Medicaid |
$5,201.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,798.28
|
| Rate for Payer: Cash Price |
$7,563.00
|
| Rate for Payer: Cigna Commercial |
$12,554.58
|
| Rate for Payer: First Health Commercial |
$14,369.70
|
| Rate for Payer: Humana Commercial |
$12,857.10
|
| Rate for Payer: Humana KY Medicaid |
$5,201.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,254.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,403.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,162.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,537.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,306.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,310.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,344.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.06
|
| Rate for Payer: PHCS Commercial |
$14,520.96
|
| Rate for Payer: United Healthcare All Payer |
$13,310.88
|
|
|
TBUSHNG EXCHNGE COMPNENT X-SM
|
Facility
|
IP
|
$15,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.38 |
| Max. Negotiated Rate |
$14,520.96 |
| Rate for Payer: Aetna Commercial |
$11,647.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,798.28
|
| Rate for Payer: Cash Price |
$7,563.00
|
| Rate for Payer: Cigna Commercial |
$12,554.58
|
| Rate for Payer: First Health Commercial |
$14,369.70
|
| Rate for Payer: Humana Commercial |
$12,857.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,403.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,162.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,537.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,310.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,344.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.06
|
| Rate for Payer: PHCS Commercial |
$14,520.96
|
| Rate for Payer: United Healthcare All Payer |
$13,310.88
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 L
|
Facility
|
IP
|
$68,912.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,958.66 |
| Max. Negotiated Rate |
$66,156.29 |
| Rate for Payer: Aetna Commercial |
$53,062.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,751.98
|
| Rate for Payer: Cash Price |
$34,456.40
|
| Rate for Payer: Cigna Commercial |
$57,197.62
|
| Rate for Payer: First Health Commercial |
$65,467.16
|
| Rate for Payer: Humana Commercial |
$58,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,508.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,857.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,673.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,643.26
|
| Rate for Payer: Ohio Health Group HMO |
$51,684.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,782.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,958.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,362.97
|
| Rate for Payer: PHCS Commercial |
$66,156.29
|
| Rate for Payer: United Healthcare All Payer |
$60,643.26
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 L
|
Facility
|
OP
|
$68,912.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,958.66 |
| Max. Negotiated Rate |
$66,156.29 |
| Rate for Payer: Aetna Commercial |
$53,062.86
|
| Rate for Payer: Anthem Medicaid |
$23,699.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,751.98
|
| Rate for Payer: Cash Price |
$34,456.40
|
| Rate for Payer: Cigna Commercial |
$57,197.62
|
| Rate for Payer: First Health Commercial |
$65,467.16
|
| Rate for Payer: Humana Commercial |
$58,575.88
|
| Rate for Payer: Humana KY Medicaid |
$23,699.11
|
| Rate for Payer: Kentucky WC Medicaid |
$23,940.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,508.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,857.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,673.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,174.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,643.26
|
| Rate for Payer: Ohio Health Group HMO |
$51,684.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,782.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,958.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,362.97
|
| Rate for Payer: PHCS Commercial |
$66,156.29
|
| Rate for Payer: United Healthcare All Payer |
$60,643.26
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 R
|
Facility
|
IP
|
$35,739.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,646.15 |
| Max. Negotiated Rate |
$34,310.01 |
| Rate for Payer: Aetna Commercial |
$27,519.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,876.88
|
| Rate for Payer: Cash Price |
$17,869.79
|
| Rate for Payer: Cigna Commercial |
$29,663.86
|
| Rate for Payer: First Health Commercial |
$33,952.61
|
| Rate for Payer: Humana Commercial |
$30,378.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,306.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,375.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,450.84
|
| Rate for Payer: Ohio Health Group HMO |
$26,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,147.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,646.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,079.27
|
| Rate for Payer: PHCS Commercial |
$34,310.01
|
| Rate for Payer: United Healthcare All Payer |
$31,450.84
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 R
|
Facility
|
OP
|
$35,739.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,646.15 |
| Max. Negotiated Rate |
$34,310.01 |
| Rate for Payer: Aetna Commercial |
$27,519.48
|
| Rate for Payer: Anthem Medicaid |
$12,290.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,876.88
|
| Rate for Payer: Cash Price |
$17,869.79
|
| Rate for Payer: Cigna Commercial |
$29,663.86
|
| Rate for Payer: First Health Commercial |
$33,952.61
|
| Rate for Payer: Humana Commercial |
$30,378.65
|
| Rate for Payer: Humana KY Medicaid |
$12,290.85
|
| Rate for Payer: Kentucky WC Medicaid |
$12,415.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,306.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,375.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,537.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,450.84
|
| Rate for Payer: Ohio Health Group HMO |
$26,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,147.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,646.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,079.27
|
| Rate for Payer: PHCS Commercial |
$34,310.01
|
| Rate for Payer: United Healthcare All Payer |
$31,450.84
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 L
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 L
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 R
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 R
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 2 R
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 2 R
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 3 L
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 3 L
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 3 R
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 3 R
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 4 L
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 4 L
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 4 R
|
Facility
|
IP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 4 R
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
|
TC3 PFC SIGMA FEM SZ 5 L
|
Facility
|
OP
|
$38,766.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,039.60 |
| Max. Negotiated Rate |
$37,215.52 |
| Rate for Payer: Aetna Commercial |
$29,849.95
|
| Rate for Payer: Anthem Medicaid |
$13,331.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,237.61
|
| Rate for Payer: Cash Price |
$19,383.08
|
| Rate for Payer: Cigna Commercial |
$32,175.92
|
| Rate for Payer: First Health Commercial |
$36,827.86
|
| Rate for Payer: Humana Commercial |
$32,951.24
|
| Rate for Payer: Humana KY Medicaid |
$13,331.69
|
| Rate for Payer: Kentucky WC Medicaid |
$13,467.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,788.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,609.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,629.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,599.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,114.23
|
| Rate for Payer: Ohio Health Group HMO |
$29,074.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,753.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,039.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,017.51
|
| Rate for Payer: PHCS Commercial |
$37,215.52
|
| Rate for Payer: United Healthcare All Payer |
$34,114.23
|
|
