|
GII CR HA POROUS FEM SZ 5 LT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 5 LT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 5 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 5 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 6 LT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 6 LT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 6 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 6 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 7 LT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 7 LT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 7 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 7 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 8 LT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 8 LT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 8 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII CR HA POROUS FEM SZ 8 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
G II DISHED INS SZ 1-2 11MM
|
Facility
|
IP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 11MM
|
Facility
|
OP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem Medicaid |
$1,871.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Humana KY Medicaid |
$1,871.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,908.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 13MM
|
Facility
|
IP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 13MM
|
Facility
|
OP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem Medicaid |
$1,871.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Humana KY Medicaid |
$1,871.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,908.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 15MM
|
Facility
|
OP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem Medicaid |
$1,871.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Humana KY Medicaid |
$1,871.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,908.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 15MM
|
Facility
|
IP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 18MM
|
Facility
|
IP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 18MM
|
Facility
|
OP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem Medicaid |
$1,871.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Humana KY Medicaid |
$1,871.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,908.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 21MM
|
Facility
|
IP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
