|
TRTHLN PS FEM COMP BEADED #8R
|
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 SYMMETRIC PAT S36M*10M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRTHLN SYMMETRIC PAT S36M*10M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRTHLN SYMMETRIC PAT S39M*11M
|
Facility
|
IP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRTHLN SYMMETRIC PAT S39M*11M
|
Facility
|
OP
|
$5,179.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.30 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$3,987.98
|
| Rate for Payer: Anthem Medicaid |
$1,781.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,039.78
|
| Rate for Payer: Cash Price |
$2,589.60
|
| Rate for Payer: Cigna Commercial |
$4,298.74
|
| Rate for Payer: First Health Commercial |
$4,920.24
|
| Rate for Payer: Humana Commercial |
$4,402.32
|
| Rate for Payer: Humana KY Medicaid |
$1,781.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,246.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,553.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,816.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,884.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$673.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.55
|
| Rate for Payer: PHCS Commercial |
$4,972.03
|
| Rate for Payer: United Healthcare All Payer |
$4,557.70
|
|
|
TRTHNUM RVSN ACTBLR SHLL 701
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTHNUM RVSN ACTBLR SHLL 701
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTHUM RVSN ACTBLR SHLL 58E
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTHUM RVSN ACTBLR SHLL 58E
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR 64G
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR 64G
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 54E
|
Facility
|
IP
|
$18,480.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,402.51 |
| Max. Negotiated Rate |
$17,741.61 |
| Rate for Payer: Aetna Commercial |
$14,230.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,415.06
|
| Rate for Payer: Cash Price |
$9,240.42
|
| Rate for Payer: Cigna Commercial |
$15,339.10
|
| Rate for Payer: First Health Commercial |
$17,556.80
|
| Rate for Payer: Humana Commercial |
$15,708.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,154.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,638.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,544.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,263.14
|
| Rate for Payer: Ohio Health Group HMO |
$13,860.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,402.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.06
|
| Rate for Payer: PHCS Commercial |
$17,741.61
|
| Rate for Payer: United Healthcare All Payer |
$16,263.14
|
|
|
TRTNUM RVSN ACTBLR SHLL 54E
|
Facility
|
OP
|
$18,480.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,402.51 |
| Max. Negotiated Rate |
$17,741.61 |
| Rate for Payer: Aetna Commercial |
$14,230.25
|
| Rate for Payer: Anthem Medicaid |
$6,355.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,415.06
|
| Rate for Payer: Cash Price |
$9,240.42
|
| Rate for Payer: Cigna Commercial |
$15,339.10
|
| Rate for Payer: First Health Commercial |
$17,556.80
|
| Rate for Payer: Humana Commercial |
$15,708.71
|
| Rate for Payer: Humana KY Medicaid |
$6,355.56
|
| Rate for Payer: Kentucky WC Medicaid |
$6,420.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,154.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,638.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,544.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,483.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,263.14
|
| Rate for Payer: Ohio Health Group HMO |
$13,860.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,402.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.06
|
| Rate for Payer: PHCS Commercial |
$17,741.61
|
| Rate for Payer: United Healthcare All Payer |
$16,263.14
|
|
|
TRTNUM RVSN ACTBLR SHLL 56E
|
Facility
|
OP
|
$16,522.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.96 |
| Max. Negotiated Rate |
$15,861.89 |
| Rate for Payer: Aetna Commercial |
$12,722.56
|
| Rate for Payer: Anthem Medicaid |
$5,682.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,887.78
|
| Rate for Payer: Cash Price |
$8,261.40
|
| Rate for Payer: Cigna Commercial |
$13,713.92
|
| Rate for Payer: First Health Commercial |
$15,696.66
|
| Rate for Payer: Humana Commercial |
$14,044.38
|
| Rate for Payer: Humana KY Medicaid |
$5,682.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,740.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,548.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,193.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,956.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,796.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,540.06
|
| Rate for Payer: Ohio Health Group HMO |
$12,392.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,304.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,147.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,122.07
|
| Rate for Payer: PHCS Commercial |
$15,861.89
|
| Rate for Payer: United Healthcare All Payer |
$14,540.06
|
|
|
TRTNUM RVSN ACTBLR SHLL 56E
|
Facility
|
IP
|
$16,522.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,147.96 |
| Max. Negotiated Rate |
$15,861.89 |
| Rate for Payer: Aetna Commercial |
$12,722.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,887.78
|
| Rate for Payer: Cash Price |
$8,261.40
|
| Rate for Payer: Cigna Commercial |
$13,713.92
|
| Rate for Payer: First Health Commercial |
$15,696.66
|
| Rate for Payer: Humana Commercial |
$14,044.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,548.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,193.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,956.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,540.06
|
| Rate for Payer: Ohio Health Group HMO |
$12,392.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,304.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,147.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,122.07
|
| Rate for Payer: PHCS Commercial |
$15,861.89
|
| Rate for Payer: United Healthcare All Payer |
$14,540.06
|
|
|
TRTNUM RVSN ACTBLR SHLL 60F
|
Facility
|
IP
|
$17,931.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.09 |
| Max. Negotiated Rate |
$17,214.22 |
| Rate for Payer: Aetna Commercial |
$13,807.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,986.55
|
| Rate for Payer: Cash Price |
$8,965.74
|
| Rate for Payer: Cigna Commercial |
$14,883.13
|
| Rate for Payer: First Health Commercial |
$17,034.91
|
| Rate for Payer: Humana Commercial |
$15,241.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,703.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,233.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,379.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,779.70
|
| Rate for Payer: Ohio Health Group HMO |
$13,448.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,586.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,331.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,558.76
|
| Rate for Payer: PHCS Commercial |
$17,214.22
|
| Rate for Payer: United Healthcare All Payer |
$15,779.70
|
|
|
TRTNUM RVSN ACTBLR SHLL 60F
|
Facility
|
OP
|
$17,931.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.09 |
| Max. Negotiated Rate |
$17,214.22 |
| Rate for Payer: Aetna Commercial |
$13,807.24
|
| Rate for Payer: Anthem Medicaid |
$6,166.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,986.55
|
| Rate for Payer: Cash Price |
$8,965.74
|
| Rate for Payer: Cigna Commercial |
$14,883.13
|
| Rate for Payer: First Health Commercial |
$17,034.91
|
| Rate for Payer: Humana Commercial |
$15,241.76
|
| Rate for Payer: Humana KY Medicaid |
$6,166.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,229.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,703.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,233.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,379.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,290.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,779.70
|
| Rate for Payer: Ohio Health Group HMO |
$13,448.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,586.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,331.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,558.76
|
| Rate for Payer: PHCS Commercial |
$17,214.22
|
| Rate for Payer: United Healthcare All Payer |
$15,779.70
|
|
|
TRTNUM RVSN ACTBLR SHLL 62G
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 62G
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 66G
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 66G
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 68G
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 68G
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 721
|
Facility
|
IP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
|
TRTNUM RVSN ACTBLR SHLL 721
|
Facility
|
OP
|
$16,180.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,103.50 |
| Max. Negotiated Rate |
$15,533.57 |
| Rate for Payer: Aetna Commercial |
$12,459.22
|
| Rate for Payer: Anthem Medicaid |
$5,564.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,621.02
|
| Rate for Payer: Cash Price |
$8,090.40
|
| Rate for Payer: Cigna Commercial |
$13,430.06
|
| Rate for Payer: First Health Commercial |
$15,371.76
|
| Rate for Payer: Humana Commercial |
$13,753.68
|
| Rate for Payer: Humana KY Medicaid |
$5,564.58
|
| Rate for Payer: Kentucky WC Medicaid |
$5,621.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,268.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,941.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,854.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,676.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,239.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,135.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,236.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,103.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,016.05
|
| Rate for Payer: PHCS Commercial |
$15,533.57
|
| Rate for Payer: United Healthcare All Payer |
$14,239.10
|
|
