|
TRI PRESS FIT STEM 22MM*150MM
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 22MM*150MM
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 23MM*100MM
|
Facility
|
IP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 23MM*100MM
|
Facility
|
OP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem Medicaid |
$2,527.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Humana KY Medicaid |
$2,527.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,553.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,578.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 23MM*150MM
|
Facility
|
IP
|
$8,069.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,420.74 |
| Max. Negotiated Rate |
$7,746.36 |
| Rate for Payer: Aetna Commercial |
$6,213.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,293.91
|
| Rate for Payer: Cash Price |
$4,034.56
|
| Rate for Payer: Cigna Commercial |
$6,697.37
|
| Rate for Payer: First Health Commercial |
$7,665.66
|
| Rate for Payer: Humana Commercial |
$6,858.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,616.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,955.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,420.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,100.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,051.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,455.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,020.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,567.69
|
| Rate for Payer: PHCS Commercial |
$7,746.36
|
| Rate for Payer: United Healthcare All Payer |
$7,100.83
|
|
|
TRI PRESS FIT STEM 23MM*150MM
|
Facility
|
OP
|
$8,069.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,420.74 |
| Max. Negotiated Rate |
$7,746.36 |
| Rate for Payer: Aetna Commercial |
$6,213.22
|
| Rate for Payer: Anthem Medicaid |
$2,774.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,293.91
|
| Rate for Payer: Cash Price |
$4,034.56
|
| Rate for Payer: Cigna Commercial |
$6,697.37
|
| Rate for Payer: First Health Commercial |
$7,665.66
|
| Rate for Payer: Humana Commercial |
$6,858.75
|
| Rate for Payer: Humana KY Medicaid |
$2,774.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,803.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,616.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,955.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,420.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,830.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,100.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,051.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,455.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,020.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,567.69
|
| Rate for Payer: PHCS Commercial |
$7,746.36
|
| Rate for Payer: United Healthcare All Payer |
$7,100.83
|
|
|
TRI PRESS FIT STEM 24MM*100MM
|
Facility
|
IP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 24MM*100MM
|
Facility
|
OP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem Medicaid |
$2,527.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Humana KY Medicaid |
$2,527.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,553.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,578.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 24MM*150MM
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 24MM*150MM
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 25MM*100MM
|
Facility
|
IP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 25MM*100MM
|
Facility
|
OP
|
$7,348.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,204.69 |
| Max. Negotiated Rate |
$7,055.02 |
| Rate for Payer: Aetna Commercial |
$5,658.71
|
| Rate for Payer: Anthem Medicaid |
$2,527.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,732.20
|
| Rate for Payer: Cash Price |
$3,674.49
|
| Rate for Payer: Cigna Commercial |
$6,099.65
|
| Rate for Payer: First Health Commercial |
$6,981.53
|
| Rate for Payer: Humana Commercial |
$6,246.63
|
| Rate for Payer: Humana KY Medicaid |
$2,527.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,553.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,026.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,423.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,204.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,578.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,467.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,511.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,879.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,393.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,070.80
|
| Rate for Payer: PHCS Commercial |
$7,055.02
|
| Rate for Payer: United Healthcare All Payer |
$6,467.10
|
|
|
TRI PRESS FIT STEM 25MM*150MM
|
Facility
|
IP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI PRESS FIT STEM 25MM*150MM
|
Facility
|
OP
|
$8,358.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.46 |
| Max. Negotiated Rate |
$8,023.87 |
| Rate for Payer: Aetna Commercial |
$6,435.81
|
| Rate for Payer: Anthem Medicaid |
$2,874.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.40
|
| Rate for Payer: Cash Price |
$4,179.10
|
| Rate for Payer: Cigna Commercial |
$6,937.31
|
| Rate for Payer: First Health Commercial |
$7,940.29
|
| Rate for Payer: Humana Commercial |
$7,104.47
|
| Rate for Payer: Humana KY Medicaid |
$2,874.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,932.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.16
|
| Rate for Payer: PHCS Commercial |
$8,023.87
|
| Rate for Payer: United Healthcare All Payer |
$7,355.22
|
|
|
TRI RM/LL TIB AUG SZ 1 10MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI RM/LL TIB AUG SZ 1 10MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI RM/LL TIB AUG SZ 1 5MM
|
Facility
|
OP
|
$7,084.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.35 |
| Max. Negotiated Rate |
$6,801.12 |
| Rate for Payer: Aetna Commercial |
$5,455.06
|
| Rate for Payer: Anthem Medicaid |
$2,436.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.91
|
| Rate for Payer: Cash Price |
$3,542.25
|
| Rate for Payer: Cigna Commercial |
$5,880.14
|
| Rate for Payer: First Health Commercial |
$6,730.27
|
| Rate for Payer: Humana Commercial |
$6,021.82
|
| Rate for Payer: Humana KY Medicaid |
$2,436.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.31
|
| Rate for Payer: PHCS Commercial |
$6,801.12
|
| Rate for Payer: United Healthcare All Payer |
$6,234.36
|
|
|
TRI RM/LL TIB AUG SZ 1 5MM
|
Facility
|
IP
|
$7,084.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.35 |
| Max. Negotiated Rate |
$6,801.12 |
| Rate for Payer: Aetna Commercial |
$5,455.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.91
|
| Rate for Payer: Cash Price |
$3,542.25
|
| Rate for Payer: Cigna Commercial |
$5,880.14
|
| Rate for Payer: First Health Commercial |
$6,730.27
|
| Rate for Payer: Humana Commercial |
$6,021.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,888.31
|
| Rate for Payer: PHCS Commercial |
$6,801.12
|
| Rate for Payer: United Healthcare All Payer |
$6,234.36
|
|
|
TRI RM/LL TIB AUG SZ 2 10MM
|
Facility
|
OP
|
$7,422.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.81 |
| Max. Negotiated Rate |
$7,125.79 |
| Rate for Payer: Aetna Commercial |
$5,715.48
|
| Rate for Payer: Anthem Medicaid |
$2,552.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.71
|
| Rate for Payer: Cash Price |
$3,711.35
|
| Rate for Payer: Cigna Commercial |
$6,160.84
|
| Rate for Payer: First Health Commercial |
$7,051.56
|
| Rate for Payer: Humana Commercial |
$6,309.30
|
| Rate for Payer: Humana KY Medicaid |
$2,552.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,578.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,603.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,567.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,457.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,121.66
|
| Rate for Payer: PHCS Commercial |
$7,125.79
|
| Rate for Payer: United Healthcare All Payer |
$6,531.98
|
|
|
TRI RM/LL TIB AUG SZ 2 10MM
|
Facility
|
IP
|
$7,422.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,226.81 |
| Max. Negotiated Rate |
$7,125.79 |
| Rate for Payer: Aetna Commercial |
$5,715.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,789.71
|
| Rate for Payer: Cash Price |
$3,711.35
|
| Rate for Payer: Cigna Commercial |
$6,160.84
|
| Rate for Payer: First Health Commercial |
$7,051.56
|
| Rate for Payer: Humana Commercial |
$6,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,086.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,477.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,226.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,531.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,567.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,938.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,457.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,121.66
|
| Rate for Payer: PHCS Commercial |
$7,125.79
|
| Rate for Payer: United Healthcare All Payer |
$6,531.98
|
|
|
TRI RM/LL TIB AUG SZ 2 5MM
|
Facility
|
IP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI RM/LL TIB AUG SZ 2 5MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
|
TRI RM/LL TIB AUG SZ 3 10MM
|
Facility
|
OP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem Medicaid |
$2,493.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Humana KY Medicaid |
$2,493.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,519.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
TRI RM/LL TIB AUG SZ 3 10MM
|
Facility
|
IP
|
$7,251.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,175.46 |
| Max. Negotiated Rate |
$6,961.46 |
| Rate for Payer: Aetna Commercial |
$5,583.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,656.19
|
| Rate for Payer: Cash Price |
$3,625.76
|
| Rate for Payer: Cigna Commercial |
$6,018.76
|
| Rate for Payer: First Health Commercial |
$6,888.94
|
| Rate for Payer: Humana Commercial |
$6,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,351.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,175.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,381.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,438.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,801.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,308.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$6,961.46
|
| Rate for Payer: United Healthcare All Payer |
$6,381.34
|
|
|
TRI RM/LL TIB AUG SZ 3 5MM
|
Facility
|
OP
|
$7,628.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.46 |
| Max. Negotiated Rate |
$7,323.07 |
| Rate for Payer: Aetna Commercial |
$5,873.71
|
| Rate for Payer: Anthem Medicaid |
$2,623.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,950.00
|
| Rate for Payer: Cash Price |
$3,814.10
|
| Rate for Payer: Cigna Commercial |
$6,331.41
|
| Rate for Payer: First Health Commercial |
$7,246.79
|
| Rate for Payer: Humana Commercial |
$6,483.97
|
| Rate for Payer: Humana KY Medicaid |
$2,623.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,650.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,255.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,629.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,288.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,675.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,712.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,721.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,102.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,636.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,263.46
|
| Rate for Payer: PHCS Commercial |
$7,323.07
|
| Rate for Payer: United Healthcare All Payer |
$6,712.82
|
|
