|
CORAIL AMT COLLAR SIZE 16
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 18
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 18
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 20
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 20
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 8
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 8
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 9
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL AMT COLLAR SIZE 9
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM W/0 COLLAR SZ9
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM W/0 COLLAR SZ9
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM WO COLLAR SZ10
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM WO COLLAR SZ10
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM WO COLLAR SZ14
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM WO COLLAR SZ14
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM WO COLLAR SZ16
|
Facility
|
IP
|
$20,862.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,258.75 |
| Max. Negotiated Rate |
$20,028.00 |
| Rate for Payer: Aetna Commercial |
$16,064.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,272.75
|
| Rate for Payer: Cash Price |
$10,431.25
|
| Rate for Payer: Cigna Commercial |
$17,315.88
|
| Rate for Payer: First Health Commercial |
$19,819.38
|
| Rate for Payer: Humana Commercial |
$17,733.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,107.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,396.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,258.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,359.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,646.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,690.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,150.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,395.12
|
| Rate for Payer: PHCS Commercial |
$20,028.00
|
| Rate for Payer: United Healthcare All Payer |
$18,359.00
|
|
|
CORAIL FEM STEM WO COLLAR SZ16
|
Facility
|
OP
|
$20,862.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,258.75 |
| Max. Negotiated Rate |
$20,028.00 |
| Rate for Payer: Aetna Commercial |
$16,064.12
|
| Rate for Payer: Anthem Medicaid |
$7,174.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,272.75
|
| Rate for Payer: Cash Price |
$10,431.25
|
| Rate for Payer: Cigna Commercial |
$17,315.88
|
| Rate for Payer: First Health Commercial |
$19,819.38
|
| Rate for Payer: Humana Commercial |
$17,733.12
|
| Rate for Payer: Humana KY Medicaid |
$7,174.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,247.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,107.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,396.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,258.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,318.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,359.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,646.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,690.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,150.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,395.12
|
| Rate for Payer: PHCS Commercial |
$20,028.00
|
| Rate for Payer: United Healthcare All Payer |
$18,359.00
|
|
|
CORAIL FEM STEM WO COLLAR SZ18
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORAIL FEM STEM WO COLLAR SZ18
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
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 |
$686.05 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,275.21
|
| Rate for Payer: Ambetter Exchange |
$686.05
|
| Rate for Payer: Anthem Medicaid |
$782.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$686.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$823.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$686.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$686.05
|
| 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 |
$891.87
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$686.05
|
|
|
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 |
$900.00 |
| 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 |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
COR ARTERY BYPASS 5 VENOUS GRA
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 33522
|
| Hospital Charge Code |
76101305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| 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 |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| 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 |
$686.05 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,275.21
|
| Rate for Payer: Ambetter Exchange |
$686.05
|
| Rate for Payer: Anthem Medicaid |
$782.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$686.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$823.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$686.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$686.05
|
| 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 |
$891.87
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$790.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$686.05
|
|
|
CORDARONE 30MG (150MG/3ML VL)
|
Facility
|
IP
|
$77.75
|
|
|
Service Code
|
HCPCS J0282
|
| Hospital Charge Code |
25001854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.65
|
| 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 |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.65
|
| 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 |
$23.32 |
| Max. Negotiated Rate |
$74.64 |
| Rate for Payer: Aetna Commercial |
$59.87
|
| Rate for Payer: Anthem Medicaid |
$26.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.65
|
| 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: 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 |
$62.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.65
|
| Rate for Payer: PHCS Commercial |
$74.64
|
| Rate for Payer: United Healthcare All Payer |
$68.42
|
|
