|
POST FEM AUG BLOCK #11/5MM
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem Medicaid |
$1,932.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Humana KY Medicaid |
$1,932.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
POST FEM AUG BLOCK #13/10MM
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #13/10MM
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #13/5MM
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #13/5MM
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #3/10MM
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #3/10MM
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #3/5MM
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #3/5MM
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
POST FEM AUG BLOCK #5/10MM
|
Facility
|
OP
|
$5,414.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.20 |
| Max. Negotiated Rate |
$5,197.44 |
| Rate for Payer: Aetna Commercial |
$4,168.78
|
| Rate for Payer: Anthem Medicaid |
$1,861.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,222.92
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cigna Commercial |
$4,493.62
|
| Rate for Payer: First Health Commercial |
$5,143.30
|
| Rate for Payer: Humana Commercial |
$4,601.90
|
| Rate for Payer: Humana KY Medicaid |
$1,861.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,880.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,439.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,995.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,624.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,899.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,764.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,060.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,710.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.66
|
| Rate for Payer: PHCS Commercial |
$5,197.44
|
| Rate for Payer: United Healthcare All Payer |
$4,764.32
|
|
|
POST FEM AUG BLOCK #5/10MM
|
Facility
|
IP
|
$5,414.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.20 |
| Max. Negotiated Rate |
$5,197.44 |
| Rate for Payer: Aetna Commercial |
$4,168.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,222.92
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cigna Commercial |
$4,493.62
|
| Rate for Payer: First Health Commercial |
$5,143.30
|
| Rate for Payer: Humana Commercial |
$4,601.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,439.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,995.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,624.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,764.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,060.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,710.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.66
|
| Rate for Payer: PHCS Commercial |
$5,197.44
|
| Rate for Payer: United Healthcare All Payer |
$4,764.32
|
|
|
POST FEM AUG BLOCK #5/5MM
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
POST FEM AUG BLOCK #5/5MM
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem Medicaid |
$1,932.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Humana KY Medicaid |
$1,932.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
POST FEM AUG BLOCK #7/10MM
|
Facility
|
IP
|
$5,414.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.20 |
| Max. Negotiated Rate |
$5,197.44 |
| Rate for Payer: Aetna Commercial |
$4,168.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,222.92
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cigna Commercial |
$4,493.62
|
| Rate for Payer: First Health Commercial |
$5,143.30
|
| Rate for Payer: Humana Commercial |
$4,601.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,439.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,995.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,624.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,764.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,060.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,710.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.66
|
| Rate for Payer: PHCS Commercial |
$5,197.44
|
| Rate for Payer: United Healthcare All Payer |
$4,764.32
|
|
|
POST FEM AUG BLOCK #7/10MM
|
Facility
|
OP
|
$5,414.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.20 |
| Max. Negotiated Rate |
$5,197.44 |
| Rate for Payer: Aetna Commercial |
$4,168.78
|
| Rate for Payer: Anthem Medicaid |
$1,861.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,222.92
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cigna Commercial |
$4,493.62
|
| Rate for Payer: First Health Commercial |
$5,143.30
|
| Rate for Payer: Humana Commercial |
$4,601.90
|
| Rate for Payer: Humana KY Medicaid |
$1,861.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,880.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,439.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,995.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,624.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,899.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,764.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,060.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,710.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.66
|
| Rate for Payer: PHCS Commercial |
$5,197.44
|
| Rate for Payer: United Healthcare All Payer |
$4,764.32
|
|
|
POST FEM AUG BLOCK #7/5MM
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
POST FEM AUG BLOCK #7/5MM
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.40 |
| Max. Negotiated Rate |
$5,393.28 |
| Rate for Payer: Aetna Commercial |
$4,325.86
|
| Rate for Payer: Anthem Medicaid |
$1,932.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,809.00
|
| Rate for Payer: Cigna Commercial |
$4,662.94
|
| Rate for Payer: First Health Commercial |
$5,337.10
|
| Rate for Payer: Humana Commercial |
$4,775.30
|
| Rate for Payer: Humana KY Medicaid |
$1,932.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,146.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,213.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,876.42
|
| Rate for Payer: PHCS Commercial |
$5,393.28
|
| Rate for Payer: United Healthcare All Payer |
$4,943.84
|
|
|
POST RECOV DC EA 1/2HR ED
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
45000338
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.86
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
POST RECOV DC EA 1/2HR ED
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
45000338
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$12.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.86
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Humana KY Medicaid |
$12.72
|
| Rate for Payer: Kentucky WC Medicaid |
$12.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
POST TAPER 12MM*32MM LG
|
Facility
|
IP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER 12MM*32MM LG
|
Facility
|
OP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem Medicaid |
$1,644.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Humana KY Medicaid |
$1,644.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER 15.6MM*32MM LG
|
Facility
|
OP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem Medicaid |
$1,644.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Humana KY Medicaid |
$1,644.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER 15.6MM*32MM LG
|
Facility
|
IP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER 8.5MM*25MM LG
|
Facility
|
IP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
|
POST TAPER 8.5MM*25MM LG
|
Facility
|
OP
|
$4,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.75 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: Aetna Commercial |
$3,682.53
|
| Rate for Payer: Anthem Medicaid |
$1,644.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,730.35
|
| Rate for Payer: Cash Price |
$2,391.25
|
| Rate for Payer: Cigna Commercial |
$3,969.47
|
| Rate for Payer: First Health Commercial |
$4,543.38
|
| Rate for Payer: Humana Commercial |
$4,065.12
|
| Rate for Payer: Humana KY Medicaid |
$1,644.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,921.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,529.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,434.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,677.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,208.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,586.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,826.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,160.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,299.93
|
| Rate for Payer: PHCS Commercial |
$4,591.20
|
| Rate for Payer: United Healthcare All Payer |
$4,208.60
|
|
