|
TRAB MET FEM CONE AGT LG 30M R
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 40M L
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 40M L
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 40M R
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 40M R
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 50M L
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 50M L
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 50M R
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT LG 50M R
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 30ML
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 30ML
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 30MR
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 30MR
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 40ML
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 40ML
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 40MR
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 40MR
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 50ML
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 50ML
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 50MR
|
Facility
|
OP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem Medicaid |
$8,793.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Humana KY Medicaid |
$8,793.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,882.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,969.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MET FEM CONE AGT MED 50MR
|
Facility
|
IP
|
$25,568.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,323.92 |
| Max. Negotiated Rate |
$24,545.87 |
| Rate for Payer: Aetna Commercial |
$19,687.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,943.52
|
| Rate for Payer: Cash Price |
$12,784.30
|
| Rate for Payer: Cigna Commercial |
$21,221.95
|
| Rate for Payer: First Health Commercial |
$24,290.18
|
| Rate for Payer: Humana Commercial |
$21,733.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,966.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,869.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,670.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,500.38
|
| Rate for Payer: Ohio Health Group HMO |
$19,176.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,113.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,323.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,926.27
|
| Rate for Payer: PHCS Commercial |
$24,545.87
|
| Rate for Payer: United Healthcare All Payer |
$22,500.38
|
|
|
TRAB MTAL REVISION SHELL 50 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 50 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 52 MM
|
Facility
|
IP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
|
TRAB MTAL REVISION SHELL 52 MM
|
Facility
|
OP
|
$17,290.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.75 |
| Max. Negotiated Rate |
$16,598.77 |
| Rate for Payer: Aetna Commercial |
$13,313.60
|
| Rate for Payer: Anthem Medicaid |
$5,946.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,486.50
|
| Rate for Payer: Cash Price |
$8,645.20
|
| Rate for Payer: Cigna Commercial |
$14,351.02
|
| Rate for Payer: First Health Commercial |
$16,425.87
|
| Rate for Payer: Humana Commercial |
$14,696.83
|
| Rate for Payer: Humana KY Medicaid |
$5,946.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,006.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,178.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,760.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,065.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,215.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,967.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,247.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,360.02
|
| Rate for Payer: PHCS Commercial |
$16,598.77
|
| Rate for Payer: United Healthcare All Payer |
$15,215.54
|
|
