|
LPS-FLEX GSF POROUS FEM F RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
LPS-FLEX GSF POROUS FEM F RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
LPS-FLEX GSF POROUS FEM G LT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
LPS-FLEX GSF POROUS FEM G LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
LPS-FLEX GSF POROUS FEM G RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
LPS-FLEX GSF POROUS FEM G RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
LPS PROX FEM STD BODY 15^ LT
|
Facility
|
OP
|
$27,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.90 |
| Max. Negotiated Rate |
$26,598.68 |
| Rate for Payer: Aetna Commercial |
$21,334.36
|
| Rate for Payer: Anthem Medicaid |
$9,528.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.43
|
| Rate for Payer: Cash Price |
$13,853.48
|
| Rate for Payer: Cigna Commercial |
$22,996.78
|
| Rate for Payer: First Health Commercial |
$26,321.61
|
| Rate for Payer: Humana Commercial |
$23,550.92
|
| Rate for Payer: Humana KY Medicaid |
$9,528.42
|
| Rate for Payer: Kentucky WC Medicaid |
$9,625.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,719.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,382.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.16
|
| Rate for Payer: PHCS Commercial |
$26,598.68
|
| Rate for Payer: United Healthcare All Payer |
$24,382.12
|
|
|
LPS PROX FEM STD BODY 15^ LT
|
Facility
|
IP
|
$27,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.90 |
| Max. Negotiated Rate |
$26,598.68 |
| Rate for Payer: Aetna Commercial |
$21,334.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.43
|
| Rate for Payer: Cash Price |
$13,853.48
|
| Rate for Payer: Cigna Commercial |
$22,996.78
|
| Rate for Payer: First Health Commercial |
$26,321.61
|
| Rate for Payer: Humana Commercial |
$23,550.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,382.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.16
|
| Rate for Payer: PHCS Commercial |
$26,598.68
|
| Rate for Payer: United Healthcare All Payer |
$24,382.12
|
|
|
LPS PROX FEM STD BODY 15^ RT
|
Facility
|
OP
|
$27,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.90 |
| Max. Negotiated Rate |
$26,598.68 |
| Rate for Payer: Aetna Commercial |
$21,334.36
|
| Rate for Payer: Anthem Medicaid |
$9,528.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.43
|
| Rate for Payer: Cash Price |
$13,853.48
|
| Rate for Payer: Cigna Commercial |
$22,996.78
|
| Rate for Payer: First Health Commercial |
$26,321.61
|
| Rate for Payer: Humana Commercial |
$23,550.92
|
| Rate for Payer: Humana KY Medicaid |
$9,528.42
|
| Rate for Payer: Kentucky WC Medicaid |
$9,625.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,719.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,382.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.16
|
| Rate for Payer: PHCS Commercial |
$26,598.68
|
| Rate for Payer: United Healthcare All Payer |
$24,382.12
|
|
|
LPS PROX FEM STD BODY 15^ RT
|
Facility
|
IP
|
$27,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.90 |
| Max. Negotiated Rate |
$26,598.68 |
| Rate for Payer: Aetna Commercial |
$21,334.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.43
|
| Rate for Payer: Cash Price |
$13,853.48
|
| Rate for Payer: Cigna Commercial |
$22,996.78
|
| Rate for Payer: First Health Commercial |
$26,321.61
|
| Rate for Payer: Humana Commercial |
$23,550.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,382.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.16
|
| Rate for Payer: PHCS Commercial |
$26,598.68
|
| Rate for Payer: United Healthcare All Payer |
$24,382.12
|
|
|
LPS PROX FEM STD BODY NEUTRAL
|
Facility
|
IP
|
$67,735.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,805.63 |
| Max. Negotiated Rate |
$65,026.18 |
| Rate for Payer: Aetna Commercial |
$52,156.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,833.77
|
| Rate for Payer: Cash Price |
$33,867.80
|
| Rate for Payer: Cigna Commercial |
$56,220.55
|
| Rate for Payer: First Health Commercial |
$64,348.82
|
| Rate for Payer: Humana Commercial |
$57,575.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,543.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,988.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,320.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,607.33
|
| Rate for Payer: Ohio Health Group HMO |
$50,801.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,547.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,805.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,998.04
|
| Rate for Payer: PHCS Commercial |
$65,026.18
|
| Rate for Payer: United Healthcare All Payer |
$59,607.33
|
|
|
LPS PROX FEM STD BODY NEUTRAL
|
Facility
|
OP
|
$67,735.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,805.63 |
| Max. Negotiated Rate |
$65,026.18 |
| Rate for Payer: Aetna Commercial |
$52,156.41
|
| Rate for Payer: Anthem Medicaid |
$23,294.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,833.77
|
| Rate for Payer: Cash Price |
$33,867.80
|
| Rate for Payer: Cigna Commercial |
$56,220.55
|
| Rate for Payer: First Health Commercial |
$64,348.82
|
| Rate for Payer: Humana Commercial |
$57,575.26
|
| Rate for Payer: Humana KY Medicaid |
$23,294.27
|
| Rate for Payer: Kentucky WC Medicaid |
$23,531.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,543.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,988.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,320.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,761.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,607.33
|
| Rate for Payer: Ohio Health Group HMO |
$50,801.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,547.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,805.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,998.04
|
| Rate for Payer: PHCS Commercial |
$65,026.18
|
| Rate for Payer: United Healthcare All Payer |
$59,607.33
|
|
|
LPS PROX FEM TROC BODY 15^ LT
|
Facility
|
OP
|
$27,706.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.87 |
| Max. Negotiated Rate |
$26,598.40 |
| Rate for Payer: Aetna Commercial |
$21,334.14
|
| Rate for Payer: Anthem Medicaid |
$9,528.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.20
|
| Rate for Payer: Cash Price |
$13,853.33
|
| Rate for Payer: Cigna Commercial |
$22,996.54
|
| Rate for Payer: First Health Commercial |
$26,321.34
|
| Rate for Payer: Humana Commercial |
$23,550.67
|
| Rate for Payer: Humana KY Medicaid |
$9,528.32
|
| Rate for Payer: Kentucky WC Medicaid |
$9,625.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,719.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,381.87
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.07
|
| Rate for Payer: PHCS Commercial |
$26,598.40
|
| Rate for Payer: United Healthcare All Payer |
$24,381.87
|
|
|
LPS PROX FEM TROC BODY 15^ LT
|
Facility
|
IP
|
$27,706.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.87 |
| Max. Negotiated Rate |
$26,598.40 |
| Rate for Payer: Aetna Commercial |
$21,334.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.20
|
| Rate for Payer: Cash Price |
$13,853.33
|
| Rate for Payer: Cigna Commercial |
$22,996.54
|
| Rate for Payer: First Health Commercial |
$26,321.34
|
| Rate for Payer: Humana Commercial |
$23,550.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,381.87
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.07
|
| Rate for Payer: PHCS Commercial |
$26,598.40
|
| Rate for Payer: United Healthcare All Payer |
$24,381.87
|
|
|
LPS PROX FEM TROC BODY 15^ RT
|
Facility
|
IP
|
$29,539.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,840.16 |
| Max. Negotiated Rate |
$28,358.11 |
| Rate for Payer: Aetna Commercial |
$22,745.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,040.97
|
| Rate for Payer: Cash Price |
$14,769.85
|
| Rate for Payer: Cigna Commercial |
$24,517.95
|
| Rate for Payer: First Health Commercial |
$28,062.72
|
| Rate for Payer: Humana Commercial |
$25,108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,800.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,994.94
|
| Rate for Payer: Ohio Health Group HMO |
$22,154.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,907.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,157.31
|
| Rate for Payer: PHCS Commercial |
$28,358.11
|
| Rate for Payer: United Healthcare All Payer |
$25,994.94
|
|
|
LPS PROX FEM TROC BODY 15^ RT
|
Facility
|
OP
|
$29,539.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,840.16 |
| Max. Negotiated Rate |
$28,358.11 |
| Rate for Payer: Aetna Commercial |
$22,745.57
|
| Rate for Payer: Anthem Medicaid |
$10,158.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,040.97
|
| Rate for Payer: Cash Price |
$14,769.85
|
| Rate for Payer: Cigna Commercial |
$24,517.95
|
| Rate for Payer: First Health Commercial |
$28,062.72
|
| Rate for Payer: Humana Commercial |
$25,108.74
|
| Rate for Payer: Humana KY Medicaid |
$10,158.70
|
| Rate for Payer: Kentucky WC Medicaid |
$10,262.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,800.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,362.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,994.94
|
| Rate for Payer: Ohio Health Group HMO |
$22,154.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,907.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,157.31
|
| Rate for Payer: PHCS Commercial |
$28,358.11
|
| Rate for Payer: United Healthcare All Payer |
$25,994.94
|
|
|
LPS PROX FEM TROC BODY NEUTRAL
|
Facility
|
OP
|
$27,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.90 |
| Max. Negotiated Rate |
$26,598.68 |
| Rate for Payer: Aetna Commercial |
$21,334.36
|
| Rate for Payer: Anthem Medicaid |
$9,528.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.43
|
| Rate for Payer: Cash Price |
$13,853.48
|
| Rate for Payer: Cigna Commercial |
$22,996.78
|
| Rate for Payer: First Health Commercial |
$26,321.61
|
| Rate for Payer: Humana Commercial |
$23,550.92
|
| Rate for Payer: Humana KY Medicaid |
$9,528.42
|
| Rate for Payer: Kentucky WC Medicaid |
$9,625.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,719.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,382.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.16
|
| Rate for Payer: PHCS Commercial |
$26,598.68
|
| Rate for Payer: United Healthcare All Payer |
$24,382.12
|
|
|
LPS PROX FEM TROC BODY NEUTRAL
|
Facility
|
IP
|
$27,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.90 |
| Max. Negotiated Rate |
$26,598.68 |
| Rate for Payer: Aetna Commercial |
$21,334.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,611.43
|
| Rate for Payer: Cash Price |
$13,853.48
|
| Rate for Payer: Cigna Commercial |
$22,996.78
|
| Rate for Payer: First Health Commercial |
$26,321.61
|
| Rate for Payer: Humana Commercial |
$23,550.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,719.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,447.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,312.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,382.12
|
| Rate for Payer: Ohio Health Group HMO |
$20,780.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,601.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,589.16
|
| Rate for Payer: PHCS Commercial |
$26,598.68
|
| Rate for Payer: United Healthcare All Payer |
$24,382.12
|
|
|
LPS SEGMENTAL COMP 105MM
|
Facility
|
OP
|
$11,534.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.47 |
| Max. Negotiated Rate |
$11,073.02 |
| Rate for Payer: Aetna Commercial |
$8,881.49
|
| Rate for Payer: Anthem Medicaid |
$3,966.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,996.83
|
| Rate for Payer: Cash Price |
$5,767.20
|
| Rate for Payer: Cigna Commercial |
$9,573.55
|
| Rate for Payer: First Health Commercial |
$10,957.68
|
| Rate for Payer: Humana Commercial |
$9,804.24
|
| Rate for Payer: Humana KY Medicaid |
$3,966.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,007.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,458.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,512.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,460.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,046.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,150.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,650.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,306.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,575.66
|
| Rate for Payer: PHCS Commercial |
$11,073.02
|
| Rate for Payer: United Healthcare All Payer |
$10,150.27
|
|
|
LPS SEGMENTAL COMP 105MM
|
Facility
|
IP
|
$11,534.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,499.47 |
| Max. Negotiated Rate |
$11,073.02 |
| Rate for Payer: Aetna Commercial |
$8,881.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,996.83
|
| Rate for Payer: Cash Price |
$5,767.20
|
| Rate for Payer: Cigna Commercial |
$9,573.55
|
| Rate for Payer: First Health Commercial |
$10,957.68
|
| Rate for Payer: Humana Commercial |
$9,804.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,458.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,512.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,460.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,150.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,650.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,306.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,575.66
|
| Rate for Payer: PHCS Commercial |
$11,073.02
|
| Rate for Payer: United Healthcare All Payer |
$10,150.27
|
|
|
LPS SEGMENTAL COMP 125MM
|
Facility
|
IP
|
$12,377.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.08 |
| Max. Negotiated Rate |
$11,882.45 |
| Rate for Payer: Aetna Commercial |
$9,530.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,654.49
|
| Rate for Payer: Cash Price |
$6,188.77
|
| Rate for Payer: Cigna Commercial |
$10,273.37
|
| Rate for Payer: First Health Commercial |
$11,758.67
|
| Rate for Payer: Humana Commercial |
$10,520.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,149.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,134.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,713.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,892.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,283.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,475.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,837.04
|
| Rate for Payer: PHCS Commercial |
$11,882.45
|
| Rate for Payer: United Healthcare All Payer |
$10,892.24
|
|
|
LPS SEGMENTAL COMP 125MM
|
Facility
|
OP
|
$12,377.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.08 |
| Max. Negotiated Rate |
$11,882.45 |
| Rate for Payer: Aetna Commercial |
$9,530.71
|
| Rate for Payer: Anthem Medicaid |
$4,256.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,654.49
|
| Rate for Payer: Cash Price |
$6,188.77
|
| Rate for Payer: Cigna Commercial |
$10,273.37
|
| Rate for Payer: First Health Commercial |
$11,758.67
|
| Rate for Payer: Humana Commercial |
$10,520.92
|
| Rate for Payer: Humana KY Medicaid |
$4,256.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,299.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,149.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,134.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,713.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,342.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,892.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,283.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,475.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,837.04
|
| Rate for Payer: PHCS Commercial |
$11,882.45
|
| Rate for Payer: United Healthcare All Payer |
$10,892.24
|
|
|
LPS SEGMENTAL COMP 25MM
|
Facility
|
OP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem Medicaid |
$4,265.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Humana KY Medicaid |
$4,265.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,308.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,350.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 25MM
|
Facility
|
IP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 30MM
|
Facility
|
OP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem Medicaid |
$4,265.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Humana KY Medicaid |
$4,265.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,308.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,350.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
