|
CORAIL2 LAT COXA VARA SIZE 14
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 14
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 15
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 15
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 16
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 16
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 18
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 18
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 20
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 LAT COXA VARA SIZE 20
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 LAT COXA VARA SIZE 9
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 9
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 STD SIZE 10
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 10
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 11
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 11
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 12
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 12
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 13
|
Facility
|
IP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 13
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
|
CORAIL2 STD SIZE 14
|
Facility
|
OP
|
$21,499.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.92 |
| Max. Negotiated Rate |
$20,639.40 |
| Rate for Payer: Aetna Commercial |
$16,554.51
|
| Rate for Payer: Anthem Medicaid |
$7,393.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.51
|
| Rate for Payer: Cash Price |
$10,749.69
|
| Rate for Payer: Cigna Commercial |
$17,844.48
|
| Rate for Payer: First Health Commercial |
$20,424.40
|
| Rate for Payer: Humana Commercial |
$18,274.46
|
| Rate for Payer: Humana KY Medicaid |
$7,393.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,468.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,629.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,541.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,919.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.80
|
| Rate for Payer: PHCS Commercial |
$20,639.40
|
| Rate for Payer: United Healthcare All Payer |
$18,919.45
|
|
|
CORAIL2 STD SIZE 14
|
Facility
|
IP
|
$21,499.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.92 |
| Max. Negotiated Rate |
$20,639.40 |
| Rate for Payer: Aetna Commercial |
$16,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.51
|
| Rate for Payer: Cash Price |
$10,749.69
|
| Rate for Payer: Cigna Commercial |
$17,844.48
|
| Rate for Payer: First Health Commercial |
$20,424.40
|
| Rate for Payer: Humana Commercial |
$18,274.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,629.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,919.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.80
|
| Rate for Payer: PHCS Commercial |
$20,639.40
|
| Rate for Payer: United Healthcare All Payer |
$18,919.45
|
|
|
CORAIL2 STD SIZE 15
|
Facility
|
IP
|
$20,239.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,631.14 |
| Max. Negotiated Rate |
$19,429.92 |
| Rate for Payer: Aetna Commercial |
$15,584.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,786.81
|
| Rate for Payer: Cash Price |
$10,119.75
|
| Rate for Payer: Cigna Commercial |
$16,798.78
|
| Rate for Payer: First Health Commercial |
$19,227.52
|
| Rate for Payer: Humana Commercial |
$17,203.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,596.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,936.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,071.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,810.76
|
| Rate for Payer: Ohio Health Group HMO |
$15,179.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,047.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,631.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,274.24
|
| Rate for Payer: PHCS Commercial |
$19,429.92
|
| Rate for Payer: United Healthcare All Payer |
$17,810.76
|
|
|
CORAIL2 STD SIZE 15
|
Facility
|
OP
|
$20,239.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,631.14 |
| Max. Negotiated Rate |
$19,429.92 |
| Rate for Payer: Aetna Commercial |
$15,584.42
|
| Rate for Payer: Anthem Medicaid |
$6,960.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,786.81
|
| Rate for Payer: Cash Price |
$10,119.75
|
| Rate for Payer: Cigna Commercial |
$16,798.78
|
| Rate for Payer: First Health Commercial |
$19,227.52
|
| Rate for Payer: Humana Commercial |
$17,203.58
|
| Rate for Payer: Humana KY Medicaid |
$6,960.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,031.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,596.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,936.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,071.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,100.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,810.76
|
| Rate for Payer: Ohio Health Group HMO |
$15,179.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,047.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,631.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,274.24
|
| Rate for Payer: PHCS Commercial |
$19,429.92
|
| Rate for Payer: United Healthcare All Payer |
$17,810.76
|
|
|
CORAIL2 STD SIZE 16
|
Facility
|
OP
|
$22,501.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.23 |
| Max. Negotiated Rate |
$21,601.70 |
| Rate for Payer: Aetna Commercial |
$17,326.36
|
| Rate for Payer: Anthem Medicaid |
$7,738.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.38
|
| Rate for Payer: Cash Price |
$11,250.89
|
| Rate for Payer: Cigna Commercial |
$18,676.47
|
| Rate for Payer: First Health Commercial |
$21,376.68
|
| Rate for Payer: Humana Commercial |
$19,126.50
|
| Rate for Payer: Humana KY Medicaid |
$7,738.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,451.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,801.56
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.55
|
| Rate for Payer: PHCS Commercial |
$21,601.70
|
| Rate for Payer: United Healthcare All Payer |
$19,801.56
|
|
