|
TAXOTERE 1MG (20MG VL)
|
Facility
|
OP
|
$594.05
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
25002603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.22 |
| Max. Negotiated Rate |
$570.29 |
| Rate for Payer: Aetna Commercial |
$457.42
|
| Rate for Payer: Anthem Medicaid |
$204.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.36
|
| Rate for Payer: Cash Price |
$297.02
|
| Rate for Payer: Cigna Commercial |
$493.06
|
| Rate for Payer: First Health Commercial |
$564.35
|
| Rate for Payer: Humana Commercial |
$504.94
|
| Rate for Payer: Humana KY Medicaid |
$204.29
|
| Rate for Payer: Kentucky WC Medicaid |
$206.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.76
|
| Rate for Payer: Ohio Health Group HMO |
$445.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.89
|
| Rate for Payer: PHCS Commercial |
$570.29
|
| Rate for Payer: United Healthcare All Payer |
$522.76
|
|
|
TAXOTERE 1MG (80MG VIAL)
|
Facility
|
IP
|
$2,370.75
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
25002604
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$711.23 |
| 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 |
$711.23
|
| 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 |
$1,896.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,635.82
|
| 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 |
$711.23 |
| 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 |
$711.23
|
| 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 |
$1,896.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,062.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,635.82
|
| Rate for Payer: PHCS Commercial |
$2,275.92
|
| Rate for Payer: United Healthcare All Payer |
$2,086.26
|
|
|
TBUSHING EXCNGE COMPONENT SM
|
Facility
|
OP
|
$15,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,688.85 |
| Max. Negotiated Rate |
$15,004.32 |
| Rate for Payer: Aetna Commercial |
$12,034.72
|
| Rate for Payer: Anthem Medicaid |
$5,374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.01
|
| Rate for Payer: Cash Price |
$7,814.75
|
| Rate for Payer: Cigna Commercial |
$12,972.49
|
| Rate for Payer: First Health Commercial |
$14,848.02
|
| Rate for Payer: Humana Commercial |
$13,285.08
|
| Rate for Payer: Humana KY Medicaid |
$5,374.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,429.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,688.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,482.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,753.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,597.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,784.35
|
| Rate for Payer: PHCS Commercial |
$15,004.32
|
| Rate for Payer: United Healthcare All Payer |
$13,753.96
|
|
|
TBUSHING EXCNGE COMPONENT SM
|
Facility
|
IP
|
$15,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,688.85 |
| Max. Negotiated Rate |
$15,004.32 |
| Rate for Payer: Aetna Commercial |
$12,034.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.01
|
| Rate for Payer: Cash Price |
$7,814.75
|
| Rate for Payer: Cigna Commercial |
$12,972.49
|
| Rate for Payer: First Health Commercial |
$14,848.02
|
| Rate for Payer: Humana Commercial |
$13,285.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,688.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,753.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,597.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,784.35
|
| Rate for Payer: PHCS Commercial |
$15,004.32
|
| Rate for Payer: United Healthcare All Payer |
$13,753.96
|
|
|
TBUSHNG EXCHNGE COMPNENT X-SM
|
Facility
|
IP
|
$15,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,688.85 |
| Max. Negotiated Rate |
$15,004.32 |
| Rate for Payer: Aetna Commercial |
$12,034.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.01
|
| Rate for Payer: Cash Price |
$7,814.75
|
| Rate for Payer: Cigna Commercial |
$12,972.49
|
| Rate for Payer: First Health Commercial |
$14,848.02
|
| Rate for Payer: Humana Commercial |
$13,285.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,688.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,753.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,597.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,784.35
|
| Rate for Payer: PHCS Commercial |
$15,004.32
|
| Rate for Payer: United Healthcare All Payer |
$13,753.96
|
|
|
TBUSHNG EXCHNGE COMPNENT X-SM
|
Facility
|
OP
|
$15,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,688.85 |
| Max. Negotiated Rate |
$15,004.32 |
| Rate for Payer: Aetna Commercial |
$12,034.72
|
| Rate for Payer: Anthem Medicaid |
$5,374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.01
|
| Rate for Payer: Cash Price |
$7,814.75
|
| Rate for Payer: Cigna Commercial |
$12,972.49
|
| Rate for Payer: First Health Commercial |
$14,848.02
|
| Rate for Payer: Humana Commercial |
$13,285.08
|
| Rate for Payer: Humana KY Medicaid |
$5,374.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,429.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,688.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,482.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,753.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,597.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,784.35
|
| Rate for Payer: PHCS Commercial |
$15,004.32
|
| Rate for Payer: United Healthcare All Payer |
$13,753.96
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 L
|
Facility
|
OP
|
$71,102.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,330.72 |
| Max. Negotiated Rate |
$68,258.30 |
| Rate for Payer: Aetna Commercial |
$54,748.85
|
| Rate for Payer: Anthem Medicaid |
$24,452.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,459.87
|
| Rate for Payer: Cash Price |
$35,551.20
|
| Rate for Payer: Cigna Commercial |
$59,014.99
|
| Rate for Payer: First Health Commercial |
$67,547.28
|
| Rate for Payer: Humana Commercial |
$60,437.04
|
| Rate for Payer: Humana KY Medicaid |
$24,452.12
|
| Rate for Payer: Kentucky WC Medicaid |
$24,700.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,303.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,473.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,330.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,942.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,570.11
|
| Rate for Payer: Ohio Health Group HMO |
$53,326.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,881.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,859.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,060.66
|
| Rate for Payer: PHCS Commercial |
$68,258.30
|
| Rate for Payer: United Healthcare All Payer |
$62,570.11
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 L
|
Facility
|
IP
|
$71,102.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,330.72 |
| Max. Negotiated Rate |
$68,258.30 |
| Rate for Payer: Aetna Commercial |
$54,748.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,459.87
|
| Rate for Payer: Cash Price |
$35,551.20
|
| Rate for Payer: Cigna Commercial |
$59,014.99
|
| Rate for Payer: First Health Commercial |
$67,547.28
|
| Rate for Payer: Humana Commercial |
$60,437.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,303.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,473.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,330.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,570.11
|
| Rate for Payer: Ohio Health Group HMO |
$53,326.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,881.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,859.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,060.66
|
| Rate for Payer: PHCS Commercial |
$68,258.30
|
| Rate for Payer: United Healthcare All Payer |
$62,570.11
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 R
|
Facility
|
OP
|
$36,787.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,036.17 |
| Max. Negotiated Rate |
$35,315.76 |
| Rate for Payer: Aetna Commercial |
$28,326.18
|
| Rate for Payer: Anthem Medicaid |
$12,651.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,694.06
|
| Rate for Payer: Cash Price |
$18,393.62
|
| Rate for Payer: Cigna Commercial |
$30,533.42
|
| Rate for Payer: First Health Commercial |
$34,947.89
|
| Rate for Payer: Humana Commercial |
$31,269.16
|
| Rate for Payer: Humana KY Medicaid |
$12,651.14
|
| Rate for Payer: Kentucky WC Medicaid |
$12,779.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,165.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,148.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,036.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,904.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,372.78
|
| Rate for Payer: Ohio Health Group HMO |
$27,590.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,004.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,383.20
|
| Rate for Payer: PHCS Commercial |
$35,315.76
|
| Rate for Payer: United Healthcare All Payer |
$32,372.78
|
|
|
TC3 PFC SIGMA FEM SZ 1.5 R
|
Facility
|
IP
|
$36,787.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,036.17 |
| Max. Negotiated Rate |
$35,315.76 |
| Rate for Payer: Aetna Commercial |
$28,326.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,694.06
|
| Rate for Payer: Cash Price |
$18,393.62
|
| Rate for Payer: Cigna Commercial |
$30,533.42
|
| Rate for Payer: First Health Commercial |
$34,947.89
|
| Rate for Payer: Humana Commercial |
$31,269.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,165.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,148.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,036.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,372.78
|
| Rate for Payer: Ohio Health Group HMO |
$27,590.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,004.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,383.20
|
| Rate for Payer: PHCS Commercial |
$35,315.76
|
| Rate for Payer: United Healthcare All Payer |
$32,372.78
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 L
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 L
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 R
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 2.5 R
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 2 R
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 2 R
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 3 L
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 3 L
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 3 R
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 3 R
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 4 L
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 4 L
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 4 R
|
Facility
|
IP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
|
TC3 PFC SIGMA FEM SZ 4 R
|
Facility
|
OP
|
$39,896.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,969.02 |
| Max. Negotiated Rate |
$38,300.88 |
| Rate for Payer: Aetna Commercial |
$30,720.50
|
| Rate for Payer: Anthem Medicaid |
$13,720.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,119.47
|
| Rate for Payer: Cash Price |
$19,948.38
|
| Rate for Payer: Cigna Commercial |
$33,114.30
|
| Rate for Payer: First Health Commercial |
$37,901.91
|
| Rate for Payer: Humana Commercial |
$33,912.24
|
| Rate for Payer: Humana KY Medicaid |
$13,720.49
|
| Rate for Payer: Kentucky WC Medicaid |
$13,860.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,715.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,443.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,969.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,109.14
|
| Rate for Payer: Ohio Health Group HMO |
$29,922.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,917.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,710.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,528.76
|
| Rate for Payer: PHCS Commercial |
$38,300.88
|
| Rate for Payer: United Healthcare All Payer |
$35,109.14
|
|
