|
TRI PRESS FIT STEM 23MM*100MM
|
Facility
|
OP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem Medicaid |
$2,458.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Humana KY Medicaid |
$2,458.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 23MM*100MM
|
Facility
|
IP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 23MM*150MM
|
Facility
|
OP
|
$7,869.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.99 |
| Max. Negotiated Rate |
$7,554.36 |
| Rate for Payer: Aetna Commercial |
$6,059.22
|
| Rate for Payer: Anthem Medicaid |
$2,706.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,137.91
|
| Rate for Payer: Cash Price |
$3,934.56
|
| Rate for Payer: Cigna Commercial |
$6,531.37
|
| Rate for Payer: First Health Commercial |
$7,475.66
|
| Rate for Payer: Humana Commercial |
$6,688.75
|
| Rate for Payer: Humana KY Medicaid |
$2,706.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,733.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,452.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,807.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,760.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,924.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,901.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,573.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.43
|
| Rate for Payer: PHCS Commercial |
$7,554.36
|
| Rate for Payer: United Healthcare All Payer |
$6,924.83
|
|
|
TRI PRESS FIT STEM 23MM*150MM
|
Facility
|
IP
|
$7,869.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,022.99 |
| Max. Negotiated Rate |
$7,554.36 |
| Rate for Payer: Aetna Commercial |
$6,059.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,137.91
|
| Rate for Payer: Cash Price |
$3,934.56
|
| Rate for Payer: Cigna Commercial |
$6,531.37
|
| Rate for Payer: First Health Commercial |
$7,475.66
|
| Rate for Payer: Humana Commercial |
$6,688.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,452.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,807.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,924.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,901.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,573.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.43
|
| Rate for Payer: PHCS Commercial |
$7,554.36
|
| Rate for Payer: United Healthcare All Payer |
$6,924.83
|
|
|
TRI PRESS FIT STEM 24MM*100MM
|
Facility
|
OP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem Medicaid |
$2,458.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Humana KY Medicaid |
$2,458.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 24MM*100MM
|
Facility
|
IP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 24MM*150MM
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI PRESS FIT STEM 24MM*150MM
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI PRESS FIT STEM 25MM*100MM
|
Facility
|
OP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem Medicaid |
$2,458.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Humana KY Medicaid |
$2,458.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 25MM*100MM
|
Facility
|
IP
|
$7,148.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.37 |
| Max. Negotiated Rate |
$6,863.02 |
| Rate for Payer: Aetna Commercial |
$5,504.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,576.20
|
| Rate for Payer: Cash Price |
$3,574.49
|
| Rate for Payer: Cigna Commercial |
$5,933.65
|
| Rate for Payer: First Health Commercial |
$6,791.53
|
| Rate for Payer: Humana Commercial |
$6,076.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,862.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$929.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,216.18
|
| Rate for Payer: PHCS Commercial |
$6,863.02
|
| Rate for Payer: United Healthcare All Payer |
$6,291.10
|
|
|
TRI PRESS FIT STEM 25MM*150MM
|
Facility
|
OP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem Medicaid |
$2,805.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Humana KY Medicaid |
$2,805.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI PRESS FIT STEM 25MM*150MM
|
Facility
|
IP
|
$8,158.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.57 |
| Max. Negotiated Rate |
$7,831.87 |
| Rate for Payer: Aetna Commercial |
$6,281.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.40
|
| Rate for Payer: Cash Price |
$4,079.10
|
| Rate for Payer: Cigna Commercial |
$6,771.31
|
| Rate for Payer: First Health Commercial |
$7,750.29
|
| Rate for Payer: Humana Commercial |
$6,934.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,529.04
|
| Rate for Payer: PHCS Commercial |
$7,831.87
|
| Rate for Payer: United Healthcare All Payer |
$7,179.22
|
|
|
TRI RM/LL TIB AUG SZ 1 10MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI RM/LL TIB AUG SZ 1 10MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI RM/LL TIB AUG SZ 1 5MM
|
Facility
|
OP
|
$6,884.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.98 |
| Max. Negotiated Rate |
$6,609.12 |
| Rate for Payer: Aetna Commercial |
$5,301.06
|
| Rate for Payer: Anthem Medicaid |
$2,367.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.91
|
| Rate for Payer: Cash Price |
$3,442.25
|
| Rate for Payer: Cigna Commercial |
$5,714.14
|
| Rate for Payer: First Health Commercial |
$6,540.28
|
| Rate for Payer: Humana Commercial |
$5,851.82
|
| Rate for Payer: Humana KY Medicaid |
$2,367.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,391.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,645.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,415.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,058.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,163.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.20
|
| Rate for Payer: PHCS Commercial |
$6,609.12
|
| Rate for Payer: United Healthcare All Payer |
$6,058.36
|
|
|
TRI RM/LL TIB AUG SZ 1 5MM
|
Facility
|
IP
|
$6,884.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.98 |
| Max. Negotiated Rate |
$6,609.12 |
| Rate for Payer: Aetna Commercial |
$5,301.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.91
|
| Rate for Payer: Cash Price |
$3,442.25
|
| Rate for Payer: Cigna Commercial |
$5,714.14
|
| Rate for Payer: First Health Commercial |
$6,540.28
|
| Rate for Payer: Humana Commercial |
$5,851.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,645.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,058.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,163.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.20
|
| Rate for Payer: PHCS Commercial |
$6,609.12
|
| Rate for Payer: United Healthcare All Payer |
$6,058.36
|
|
|
TRI RM/LL TIB AUG SZ 2 10MM
|
Facility
|
OP
|
$7,222.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.95 |
| Max. Negotiated Rate |
$6,933.79 |
| Rate for Payer: Aetna Commercial |
$5,561.48
|
| Rate for Payer: Anthem Medicaid |
$2,483.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,633.71
|
| Rate for Payer: Cash Price |
$3,611.35
|
| Rate for Payer: Cigna Commercial |
$5,994.84
|
| Rate for Payer: First Health Commercial |
$6,861.56
|
| Rate for Payer: Humana Commercial |
$6,139.30
|
| Rate for Payer: Humana KY Medicaid |
$2,483.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,509.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,922.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,330.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,533.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,355.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,417.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.04
|
| Rate for Payer: PHCS Commercial |
$6,933.79
|
| Rate for Payer: United Healthcare All Payer |
$6,355.98
|
|
|
TRI RM/LL TIB AUG SZ 2 10MM
|
Facility
|
IP
|
$7,222.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.95 |
| Max. Negotiated Rate |
$6,933.79 |
| Rate for Payer: Aetna Commercial |
$5,561.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,633.71
|
| Rate for Payer: Cash Price |
$3,611.35
|
| Rate for Payer: Cigna Commercial |
$5,994.84
|
| Rate for Payer: First Health Commercial |
$6,861.56
|
| Rate for Payer: Humana Commercial |
$6,139.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,922.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,330.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,166.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,355.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,417.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.04
|
| Rate for Payer: PHCS Commercial |
$6,933.79
|
| Rate for Payer: United Healthcare All Payer |
$6,355.98
|
|
|
TRI RM/LL TIB AUG SZ 2 5MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI RM/LL TIB AUG SZ 2 5MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI RM/LL TIB AUG SZ 3 10MM
|
Facility
|
OP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem Medicaid |
$2,425.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Humana KY Medicaid |
$2,425.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,449.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,473.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
TRI RM/LL TIB AUG SZ 3 10MM
|
Facility
|
IP
|
$7,051.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.70 |
| Max. Negotiated Rate |
$6,769.46 |
| Rate for Payer: Aetna Commercial |
$5,429.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.19
|
| Rate for Payer: Cash Price |
$3,525.76
|
| Rate for Payer: Cigna Commercial |
$5,852.76
|
| Rate for Payer: First Health Commercial |
$6,698.94
|
| Rate for Payer: Humana Commercial |
$5,993.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,185.97
|
| Rate for Payer: PHCS Commercial |
$6,769.46
|
| Rate for Payer: United Healthcare All Payer |
$6,205.34
|
|
|
TRI RM/LL TIB AUG SZ 3 5MM
|
Facility
|
IP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI RM/LL TIB AUG SZ 3 5MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
|
TRI RM/LL TIB AUG SZ 4 10MM
|
Facility
|
OP
|
$7,428.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$7,131.07 |
| Rate for Payer: Aetna Commercial |
$5,719.71
|
| Rate for Payer: Anthem Medicaid |
$2,554.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,794.00
|
| Rate for Payer: Cash Price |
$3,714.10
|
| Rate for Payer: Cigna Commercial |
$6,165.41
|
| Rate for Payer: First Health Commercial |
$7,056.79
|
| Rate for Payer: Humana Commercial |
$6,313.97
|
| Rate for Payer: Humana KY Medicaid |
$2,554.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,580.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,091.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,482.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,228.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,605.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,536.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,571.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,485.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$965.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.74
|
| Rate for Payer: PHCS Commercial |
$7,131.07
|
| Rate for Payer: United Healthcare All Payer |
$6,536.82
|
|
