|
CORAIL AMT COLLAR 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
|
|
|
CORAIL AMT COLLAR 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
|
|
|
CORAIL AMT COLLAR SIZE 8
|
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
|
|
|
CORAIL AMT COLLAR SIZE 8
|
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
|
|
|
CORAIL AMT COLLAR SIZE 9
|
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
|
|
|
CORAIL AMT COLLAR SIZE 9
|
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
|
|
|
CORAIL FEM STEM W/0 COLLAR SZ9
|
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
|
|
|
CORAIL FEM STEM W/0 COLLAR SZ9
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ10
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ10
|
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: Cigna Commercial |
$18,676.47
|
| 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: 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
|
|
|
CORAIL FEM STEM WO COLLAR SZ14
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ14
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ16
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ16
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ18
|
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
|
|
|
CORAIL FEM STEM WO COLLAR SZ18
|
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
|
|
|
COR ARTERY BYPASS 5 VENOUS GRA
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 33522
|
| Hospital Charge Code |
76101305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
COR ARTERY BYPASS 5 VENOUS GRA
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 33522
|
| Hospital Charge Code |
761P1305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$782.40 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,275.21
|
| Rate for Payer: Anthem Medicaid |
$782.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,162.09
|
| Rate for Payer: Healthspan PPO |
$1,253.78
|
| Rate for Payer: Humana Medicaid |
$782.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.05
|
| Rate for Payer: Molina Healthcare Passport |
$782.40
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.22
|
|
|
COR ARTERY BYPASS 5 VENOUS GRA
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 33522
|
| Hospital Charge Code |
76101305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
COR ARTERY BYPASS 5 VENOUS GRA
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 33522
|
| Hospital Charge Code |
76101305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$782.40 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,275.21
|
| Rate for Payer: Anthem Medicaid |
$782.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,162.09
|
| Rate for Payer: Healthspan PPO |
$1,253.78
|
| Rate for Payer: Humana Medicaid |
$782.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.05
|
| Rate for Payer: Molina Healthcare Passport |
$782.40
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.22
|
|
|
CORDARONE 30MG (150MG/3ML VL)
|
Facility
|
IP
|
$77.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.64
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna Commercial |
$64.53
|
| Rate for Payer: First Health Commercial |
$73.86
|
| Rate for Payer: Humana Commercial |
$66.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.42
|
| Rate for Payer: Ohio Health Group HMO |
$58.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.10
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
|
|
CORDARONE 30MG (150MG/3ML VL)
|
Facility
|
OP
|
$77.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Humana Commercial |
$66.09
|
| Rate for Payer: Humana KY Medicaid |
$26.74
|
| Rate for Payer: Kentucky WC Medicaid |
$27.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.42
|
| Rate for Payer: Ohio Health Group HMO |
$58.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.10
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem Medicaid |
$26.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.64
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cigna Commercial |
$64.53
|
| Rate for Payer: First Health Commercial |
$73.86
|
|
|
CORDARONE (AMIODARO 200MG/1TAB
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 63739005110
|
| Hospital Charge Code |
25000460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
CORDARONE (AMIODARO 200MG/1TAB
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 63739005110
|
| Hospital Charge Code |
25000460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
COREG (CARVEDILOL) 12.5MG/1TAB
|
Facility
|
OP
|
$4.28
|
|
|
Service Code
|
NDC 904630261
|
| Hospital Charge Code |
25000462
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.55
|
| Rate for Payer: First Health Commercial |
$4.07
|
| Rate for Payer: Humana Commercial |
$3.64
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.77
|
| Rate for Payer: Ohio Health Group HMO |
$3.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.11
|
| Rate for Payer: United Healthcare All Payer |
$3.77
|
|
