|
TRTHLN PS FEM COMP BEADED #6L
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #6R
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #6R
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #7L
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #7L
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #7R
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #7R
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #8L
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #8L
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #8R
|
Facility
|
OP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem Medicaid |
$6,233.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Humana KY Medicaid |
$6,233.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,297.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,358.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN PS FEM COMP BEADED #8R
|
Facility
|
IP
|
$18,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,438.10 |
| Max. Negotiated Rate |
$17,401.92 |
| Rate for Payer: Aetna Commercial |
$13,957.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,139.06
|
| Rate for Payer: Cash Price |
$9,063.50
|
| Rate for Payer: Cigna Commercial |
$15,045.41
|
| Rate for Payer: First Health Commercial |
$17,220.65
|
| Rate for Payer: Humana Commercial |
$15,407.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,864.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,951.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,770.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,507.63
|
| Rate for Payer: PHCS Commercial |
$17,401.92
|
| Rate for Payer: United Healthcare All Payer |
$15,951.76
|
|
|
TRTHLN SYMMETRIC PAT S36M*10M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRTHLN SYMMETRIC PAT S36M*10M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRTHLN SYMMETRIC PAT S39M*11M
|
Facility
|
IP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRTHLN SYMMETRIC PAT S39M*11M
|
Facility
|
OP
|
$5,192.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$4,984.32 |
| Rate for Payer: Aetna Commercial |
$3,997.84
|
| Rate for Payer: Anthem Medicaid |
$1,785.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,049.76
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cigna Commercial |
$4,309.36
|
| Rate for Payer: First Health Commercial |
$4,932.40
|
| Rate for Payer: Humana Commercial |
$4,413.20
|
| Rate for Payer: Humana KY Medicaid |
$1,785.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,831.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,568.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,517.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,582.48
|
| Rate for Payer: PHCS Commercial |
$4,984.32
|
| Rate for Payer: United Healthcare All Payer |
$4,568.96
|
|
|
TRTHNUM RVSN ACTBLR SHLL 701
|
Facility
|
OP
|
$16,713.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.08 |
| Max. Negotiated Rate |
$16,045.06 |
| Rate for Payer: Aetna Commercial |
$12,869.47
|
| Rate for Payer: Anthem Medicaid |
$5,747.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,036.61
|
| Rate for Payer: Cash Price |
$8,356.80
|
| Rate for Payer: Cigna Commercial |
$13,872.29
|
| Rate for Payer: First Health Commercial |
$15,877.92
|
| Rate for Payer: Humana Commercial |
$14,206.56
|
| Rate for Payer: Humana KY Medicaid |
$5,747.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,806.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,705.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,334.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,014.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,863.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,707.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,535.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,370.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,540.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,532.38
|
| Rate for Payer: PHCS Commercial |
$16,045.06
|
| Rate for Payer: United Healthcare All Payer |
$14,707.97
|
|
|
TRTHNUM RVSN ACTBLR SHLL 701
|
Facility
|
IP
|
$16,713.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.08 |
| Max. Negotiated Rate |
$16,045.06 |
| Rate for Payer: Aetna Commercial |
$12,869.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,036.61
|
| Rate for Payer: Cash Price |
$8,356.80
|
| Rate for Payer: Cigna Commercial |
$13,872.29
|
| Rate for Payer: First Health Commercial |
$15,877.92
|
| Rate for Payer: Humana Commercial |
$14,206.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,705.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,334.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,014.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,707.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,535.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,370.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,540.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,532.38
|
| Rate for Payer: PHCS Commercial |
$16,045.06
|
| Rate for Payer: United Healthcare All Payer |
$14,707.97
|
|
|
TRTHUM RVSN ACTBLR SHLL 58E
|
Facility
|
OP
|
$16,713.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.08 |
| Max. Negotiated Rate |
$16,045.06 |
| Rate for Payer: Aetna Commercial |
$12,869.47
|
| Rate for Payer: Anthem Medicaid |
$5,747.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,036.61
|
| Rate for Payer: Cash Price |
$8,356.80
|
| Rate for Payer: Cigna Commercial |
$13,872.29
|
| Rate for Payer: First Health Commercial |
$15,877.92
|
| Rate for Payer: Humana Commercial |
$14,206.56
|
| Rate for Payer: Humana KY Medicaid |
$5,747.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,806.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,705.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,334.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,014.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,863.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,707.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,535.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,370.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,540.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,532.38
|
| Rate for Payer: PHCS Commercial |
$16,045.06
|
| Rate for Payer: United Healthcare All Payer |
$14,707.97
|
|
|
TRTHUM RVSN ACTBLR SHLL 58E
|
Facility
|
IP
|
$16,713.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.08 |
| Max. Negotiated Rate |
$16,045.06 |
| Rate for Payer: Aetna Commercial |
$12,869.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,036.61
|
| Rate for Payer: Cash Price |
$8,356.80
|
| Rate for Payer: Cigna Commercial |
$13,872.29
|
| Rate for Payer: First Health Commercial |
$15,877.92
|
| Rate for Payer: Humana Commercial |
$14,206.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,705.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,334.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,014.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,707.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,535.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,370.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,540.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,532.38
|
| Rate for Payer: PHCS Commercial |
$16,045.06
|
| Rate for Payer: United Healthcare All Payer |
$14,707.97
|
|
|
TRTNUM RVSN ACTBLR 64G
|
Facility
|
IP
|
$16,713.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.08 |
| Max. Negotiated Rate |
$16,045.06 |
| Rate for Payer: Aetna Commercial |
$12,869.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,036.61
|
| Rate for Payer: Cash Price |
$8,356.80
|
| Rate for Payer: Cigna Commercial |
$13,872.29
|
| Rate for Payer: First Health Commercial |
$15,877.92
|
| Rate for Payer: Humana Commercial |
$14,206.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,705.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,334.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,014.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,707.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,535.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,370.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,540.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,532.38
|
| Rate for Payer: PHCS Commercial |
$16,045.06
|
| Rate for Payer: United Healthcare All Payer |
$14,707.97
|
|
|
TRTNUM RVSN ACTBLR 64G
|
Facility
|
OP
|
$16,713.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,014.08 |
| Max. Negotiated Rate |
$16,045.06 |
| Rate for Payer: Aetna Commercial |
$12,869.47
|
| Rate for Payer: Anthem Medicaid |
$5,747.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,036.61
|
| Rate for Payer: Cash Price |
$8,356.80
|
| Rate for Payer: Cigna Commercial |
$13,872.29
|
| Rate for Payer: First Health Commercial |
$15,877.92
|
| Rate for Payer: Humana Commercial |
$14,206.56
|
| Rate for Payer: Humana KY Medicaid |
$5,747.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,806.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,705.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,334.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,014.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,863.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,707.97
|
| Rate for Payer: Ohio Health Group HMO |
$12,535.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,370.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,540.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,532.38
|
| Rate for Payer: PHCS Commercial |
$16,045.06
|
| Rate for Payer: United Healthcare All Payer |
$14,707.97
|
|
|
TRTNUM RVSN ACTBLR SHLL 54E
|
Facility
|
IP
|
$19,077.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,723.26 |
| Max. Negotiated Rate |
$18,314.43 |
| Rate for Payer: Aetna Commercial |
$14,689.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,880.47
|
| Rate for Payer: Cash Price |
$9,538.76
|
| Rate for Payer: Cigna Commercial |
$15,834.35
|
| Rate for Payer: First Health Commercial |
$18,123.65
|
| Rate for Payer: Humana Commercial |
$16,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,643.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,079.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,723.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,788.23
|
| Rate for Payer: Ohio Health Group HMO |
$14,308.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,262.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,597.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,163.50
|
| Rate for Payer: PHCS Commercial |
$18,314.43
|
| Rate for Payer: United Healthcare All Payer |
$16,788.23
|
|
|
TRTNUM RVSN ACTBLR SHLL 54E
|
Facility
|
OP
|
$19,077.53
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,723.26 |
| Max. Negotiated Rate |
$18,314.43 |
| Rate for Payer: Aetna Commercial |
$14,689.70
|
| Rate for Payer: Anthem Medicaid |
$6,560.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,880.47
|
| Rate for Payer: Cash Price |
$9,538.76
|
| Rate for Payer: Cigna Commercial |
$15,834.35
|
| Rate for Payer: First Health Commercial |
$18,123.65
|
| Rate for Payer: Humana Commercial |
$16,215.90
|
| Rate for Payer: Humana KY Medicaid |
$6,560.76
|
| Rate for Payer: Kentucky WC Medicaid |
$6,627.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,643.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,079.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,723.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,788.23
|
| Rate for Payer: Ohio Health Group HMO |
$14,308.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,262.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,597.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,163.50
|
| Rate for Payer: PHCS Commercial |
$18,314.43
|
| Rate for Payer: United Healthcare All Payer |
$16,788.23
|
|
|
TRTNUM RVSN ACTBLR SHLL 56E
|
Facility
|
IP
|
$17,065.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,119.53 |
| Max. Negotiated Rate |
$16,382.50 |
| Rate for Payer: Aetna Commercial |
$13,140.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,310.78
|
| Rate for Payer: Cash Price |
$8,532.55
|
| Rate for Payer: Cigna Commercial |
$14,164.03
|
| Rate for Payer: First Health Commercial |
$16,211.84
|
| Rate for Payer: Humana Commercial |
$14,505.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,993.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,594.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,119.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,017.29
|
| Rate for Payer: Ohio Health Group HMO |
$12,798.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,652.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,846.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,774.92
|
| Rate for Payer: PHCS Commercial |
$16,382.50
|
| Rate for Payer: United Healthcare All Payer |
$15,017.29
|
|
|
TRTNUM RVSN ACTBLR SHLL 56E
|
Facility
|
OP
|
$17,065.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,119.53 |
| Max. Negotiated Rate |
$16,382.50 |
| Rate for Payer: Aetna Commercial |
$13,140.13
|
| Rate for Payer: Anthem Medicaid |
$5,868.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,310.78
|
| Rate for Payer: Cash Price |
$8,532.55
|
| Rate for Payer: Cigna Commercial |
$14,164.03
|
| Rate for Payer: First Health Commercial |
$16,211.84
|
| Rate for Payer: Humana Commercial |
$14,505.33
|
| Rate for Payer: Humana KY Medicaid |
$5,868.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,928.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,993.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,594.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,119.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,986.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,017.29
|
| Rate for Payer: Ohio Health Group HMO |
$12,798.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,652.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,846.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,774.92
|
| Rate for Payer: PHCS Commercial |
$16,382.50
|
| Rate for Payer: United Healthcare All Payer |
$15,017.29
|
|
