|
TRAB MTL FEM CONE AGT SM 40M R
|
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 MTL FEM CONE AGT SM 40M R
|
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 MTL FEM CONE AGT SM 50M L
|
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 MTL FEM CONE AGT SM 50M L
|
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 MTL FEM CONE AGT SM 50M R
|
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 MTL FEM CONE AGT SM 50M R
|
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 MTL TIBCN 67STP LG 15/30R
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCN 67STP LG 15/30R
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCN 67STP LG 30/15L
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCN 67STP LG 30/15L
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 59STP M 15/30R
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 59STP M 15/30R
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 59STP M 30/15L
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 59STP M 30/15L
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 67-15M FULL LG
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 67-15M FULL LG
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 67-30M FULL LG
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIBCNE 67-30M FULL LG
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 48-15M FULXS
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 48-15M FULXS
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 52-15M FULSM
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 52-15M FULSM
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 59-15M FULLM
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 59-15M FULLM
|
Facility
|
IP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
|
TRAB MTL TIB CONE 59-30M FULLM
|
Facility
|
OP
|
$23,735.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,120.56 |
| Max. Negotiated Rate |
$22,785.78 |
| Rate for Payer: Aetna Commercial |
$18,276.10
|
| Rate for Payer: Anthem Medicaid |
$8,162.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,513.45
|
| Rate for Payer: Cash Price |
$11,867.59
|
| Rate for Payer: Cigna Commercial |
$19,700.21
|
| Rate for Payer: First Health Commercial |
$22,548.43
|
| Rate for Payer: Humana Commercial |
$20,174.91
|
| Rate for Payer: Humana KY Medicaid |
$8,162.53
|
| Rate for Payer: Kentucky WC Medicaid |
$8,245.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,120.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,326.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,886.97
|
| Rate for Payer: Ohio Health Group HMO |
$17,801.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,988.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,649.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,377.28
|
| Rate for Payer: PHCS Commercial |
$22,785.78
|
| Rate for Payer: United Healthcare All Payer |
$20,886.97
|
|
