|
TRTHLN PS FEM COMP BEADED #2R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #2R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #3L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #3L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #3R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #3R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #4L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #4L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #4R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #4R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #5L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #5L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #5R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #5R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #6L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #6L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #6R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #6R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #7L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #7L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #7R
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #7R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #8L
|
Facility
|
IP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #8L
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
|
TRTHLN PS FEM COMP BEADED #8R
|
Facility
|
OP
|
$17,556.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,282.28 |
| Max. Negotiated Rate |
$16,853.76 |
| Rate for Payer: Aetna Commercial |
$13,518.12
|
| Rate for Payer: Anthem Medicaid |
$6,037.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,693.68
|
| Rate for Payer: Cash Price |
$8,778.00
|
| Rate for Payer: Cigna Commercial |
$14,571.48
|
| Rate for Payer: First Health Commercial |
$16,678.20
|
| Rate for Payer: Humana Commercial |
$14,922.60
|
| Rate for Payer: Humana KY Medicaid |
$6,037.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,098.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,395.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,956.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,266.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,158.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,449.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,282.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,442.36
|
| Rate for Payer: PHCS Commercial |
$16,853.76
|
| Rate for Payer: United Healthcare All Payer |
$15,449.28
|
|
