|
TRAB MET FEM CONE AGT MED 30ML
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 30ML
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 30MR
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 30MR
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 40ML
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 40ML
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 40MR
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 40MR
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 50ML
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 50ML
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 50MR
|
Facility
|
IP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MET FEM CONE AGT MED 50MR
|
Facility
|
OP
|
$26,337.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,901.28 |
| Max. Negotiated Rate |
$25,284.11 |
| Rate for Payer: Aetna Commercial |
$20,279.96
|
| Rate for Payer: Anthem Medicaid |
$9,057.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,543.34
|
| Rate for Payer: Cash Price |
$13,168.81
|
| Rate for Payer: Cigna Commercial |
$21,860.22
|
| Rate for Payer: First Health Commercial |
$25,020.73
|
| Rate for Payer: Humana Commercial |
$22,386.97
|
| Rate for Payer: Humana KY Medicaid |
$9,057.50
|
| Rate for Payer: Kentucky WC Medicaid |
$9,149.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,596.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,437.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,901.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,239.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,177.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,753.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,070.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,913.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,172.95
|
| Rate for Payer: PHCS Commercial |
$25,284.11
|
| Rate for Payer: United Healthcare All Payer |
$23,177.10
|
|
|
TRAB MTAL REVISION SHELL 50 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 50 MM
|
Facility
|
IP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 52 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 52 MM
|
Facility
|
IP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 54 MM
|
Facility
|
IP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 54 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 56 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 56 MM
|
Facility
|
IP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 58 MM
|
Facility
|
IP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 58 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 60 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 60 MM
|
Facility
|
IP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
|
TRAB MTAL REVISION SHELL 62 MM
|
Facility
|
OP
|
$17,854.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,356.20 |
| Max. Negotiated Rate |
$17,139.85 |
| Rate for Payer: Aetna Commercial |
$13,747.59
|
| Rate for Payer: Anthem Medicaid |
$6,139.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,926.13
|
| Rate for Payer: Cash Price |
$8,927.01
|
| Rate for Payer: Cigna Commercial |
$14,818.83
|
| Rate for Payer: First Health Commercial |
$16,961.31
|
| Rate for Payer: Humana Commercial |
$15,175.91
|
| Rate for Payer: Humana KY Medicaid |
$6,139.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,202.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,640.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,176.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,356.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,263.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,711.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,390.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,283.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,532.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,319.27
|
| Rate for Payer: PHCS Commercial |
$17,139.85
|
| Rate for Payer: United Healthcare All Payer |
$15,711.53
|
|
