|
ADVANCE TIBIA BASE WO HOLE SZ5
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
ADVANIX 10*12CM PRELOADED STEN
|
Facility
|
OP
|
$1,962.80
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.84 |
| Max. Negotiated Rate |
$1,884.29 |
| Rate for Payer: Aetna Commercial |
$1,511.36
|
| Rate for Payer: Anthem Medicaid |
$675.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.98
|
| Rate for Payer: Cash Price |
$981.40
|
| Rate for Payer: Cigna Commercial |
$1,629.12
|
| Rate for Payer: First Health Commercial |
$1,864.66
|
| Rate for Payer: Humana Commercial |
$1,668.38
|
| Rate for Payer: Humana KY Medicaid |
$675.01
|
| Rate for Payer: Kentucky WC Medicaid |
$681.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,472.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,570.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.33
|
| Rate for Payer: PHCS Commercial |
$1,884.29
|
| Rate for Payer: United Healthcare All Payer |
$1,727.26
|
|
|
ADVANIX 10*12CM PRELOADED STEN
|
Facility
|
IP
|
$1,962.80
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.84 |
| Max. Negotiated Rate |
$1,884.29 |
| Rate for Payer: Aetna Commercial |
$1,511.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.98
|
| Rate for Payer: Cash Price |
$981.40
|
| Rate for Payer: Cigna Commercial |
$1,629.12
|
| Rate for Payer: First Health Commercial |
$1,864.66
|
| Rate for Payer: Humana Commercial |
$1,668.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,472.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,570.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.33
|
| Rate for Payer: PHCS Commercial |
$1,884.29
|
| Rate for Payer: United Healthcare All Payer |
$1,727.26
|
|
|
ADVANIX 10*5CM PRELOADED STENT
|
Facility
|
IP
|
$1,809.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.76 |
| Max. Negotiated Rate |
$1,736.83 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.18
|
| Rate for Payer: Cash Price |
$904.60
|
| Rate for Payer: Cigna Commercial |
$1,501.64
|
| Rate for Payer: First Health Commercial |
$1,718.74
|
| Rate for Payer: Humana Commercial |
$1,537.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.35
|
| Rate for Payer: PHCS Commercial |
$1,736.83
|
| Rate for Payer: United Healthcare All Payer |
$1,592.10
|
|
|
ADVANIX 10*5CM PRELOADED STENT
|
Facility
|
OP
|
$1,809.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.76 |
| Max. Negotiated Rate |
$1,736.83 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Anthem Medicaid |
$622.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.18
|
| Rate for Payer: Cash Price |
$904.60
|
| Rate for Payer: Cigna Commercial |
$1,501.64
|
| Rate for Payer: First Health Commercial |
$1,718.74
|
| Rate for Payer: Humana Commercial |
$1,537.82
|
| Rate for Payer: Humana KY Medicaid |
$622.18
|
| Rate for Payer: Kentucky WC Medicaid |
$628.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.35
|
| Rate for Payer: PHCS Commercial |
$1,736.83
|
| Rate for Payer: United Healthcare All Payer |
$1,592.10
|
|
|
ADVANIX 10*7CM PRELOADED STENT
|
Facility
|
IP
|
$1,809.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.76 |
| Max. Negotiated Rate |
$1,736.83 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.18
|
| Rate for Payer: Cash Price |
$904.60
|
| Rate for Payer: Cigna Commercial |
$1,501.64
|
| Rate for Payer: First Health Commercial |
$1,718.74
|
| Rate for Payer: Humana Commercial |
$1,537.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.35
|
| Rate for Payer: PHCS Commercial |
$1,736.83
|
| Rate for Payer: United Healthcare All Payer |
$1,592.10
|
|
|
ADVANIX 10*7CM PRELOADED STENT
|
Facility
|
OP
|
$1,809.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.76 |
| Max. Negotiated Rate |
$1,736.83 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Anthem Medicaid |
$622.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.18
|
| Rate for Payer: Cash Price |
$904.60
|
| Rate for Payer: Cigna Commercial |
$1,501.64
|
| Rate for Payer: First Health Commercial |
$1,718.74
|
| Rate for Payer: Humana Commercial |
$1,537.82
|
| Rate for Payer: Humana KY Medicaid |
$622.18
|
| Rate for Payer: Kentucky WC Medicaid |
$628.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.35
|
| Rate for Payer: PHCS Commercial |
$1,736.83
|
| Rate for Payer: United Healthcare All Payer |
$1,592.10
|
|
|
ADVANIX 10*9CM PRELOADED STENT
|
Facility
|
OP
|
$1,809.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.76 |
| Max. Negotiated Rate |
$1,736.83 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Anthem Medicaid |
$622.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.18
|
| Rate for Payer: Cash Price |
$904.60
|
| Rate for Payer: Cigna Commercial |
$1,501.64
|
| Rate for Payer: First Health Commercial |
$1,718.74
|
| Rate for Payer: Humana Commercial |
$1,537.82
|
| Rate for Payer: Humana KY Medicaid |
$622.18
|
| Rate for Payer: Kentucky WC Medicaid |
$628.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.35
|
| Rate for Payer: PHCS Commercial |
$1,736.83
|
| Rate for Payer: United Healthcare All Payer |
$1,592.10
|
|
|
ADVANIX 10*9CM PRELOADED STENT
|
Facility
|
IP
|
$1,809.20
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.76 |
| Max. Negotiated Rate |
$1,736.83 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.18
|
| Rate for Payer: Cash Price |
$904.60
|
| Rate for Payer: Cigna Commercial |
$1,501.64
|
| Rate for Payer: First Health Commercial |
$1,718.74
|
| Rate for Payer: Humana Commercial |
$1,537.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,483.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,356.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.35
|
| Rate for Payer: PHCS Commercial |
$1,736.83
|
| Rate for Payer: United Healthcare All Payer |
$1,592.10
|
|
|
ADVANTIM TIB STEM 3*10 SMOOTH
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
ADVANTIM TIB STEM 3*10 SMOOTH
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
ADVANTIM TIB STEM 6*10 SMOOTH
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
ADVANTIM TIB STEM 6*10 SMOOTH
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
ADV COCR TIB BASE NP SZ1 STD
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ1 STD
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ2 STD
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ2 STD
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ3 STD
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ3 STD
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ4 STD
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ4 STD
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ5 STD
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ5 STD
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ6 STD
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
ADV COCR TIB BASE NP SZ6 STD
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
