|
SYN FRAC MGMT FEM SZ 10
|
Facility
|
IP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN FRAC MGMT FEM SZ 10
|
Facility
|
OP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem Medicaid |
$5,523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Humana KY Medicaid |
$5,523.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,634.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN FRAC MGMT FEM SZ 11
|
Facility
|
IP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN FRAC MGMT FEM SZ 11
|
Facility
|
OP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem Medicaid |
$5,523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Humana KY Medicaid |
$5,523.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,634.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN FRAC MGMT FEM SZ 12
|
Facility
|
OP
|
$9,341.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.45 |
| Max. Negotiated Rate |
$8,967.85 |
| Rate for Payer: Aetna Commercial |
$7,192.96
|
| Rate for Payer: Anthem Medicaid |
$3,212.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,286.38
|
| Rate for Payer: Cash Price |
$4,670.76
|
| Rate for Payer: Cigna Commercial |
$7,753.45
|
| Rate for Payer: First Health Commercial |
$8,874.43
|
| Rate for Payer: Humana Commercial |
$7,940.28
|
| Rate for Payer: Humana KY Medicaid |
$3,212.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,245.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,660.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,894.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,277.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,220.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,006.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,473.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,127.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,445.64
|
| Rate for Payer: PHCS Commercial |
$8,967.85
|
| Rate for Payer: United Healthcare All Payer |
$8,220.53
|
|
|
SYN FRAC MGMT FEM SZ 12
|
Facility
|
IP
|
$9,341.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.45 |
| Max. Negotiated Rate |
$8,967.85 |
| Rate for Payer: Aetna Commercial |
$7,192.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,286.38
|
| Rate for Payer: Cash Price |
$4,670.76
|
| Rate for Payer: Cigna Commercial |
$7,753.45
|
| Rate for Payer: First Health Commercial |
$8,874.43
|
| Rate for Payer: Humana Commercial |
$7,940.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,660.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,894.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,220.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,006.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,473.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,127.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,445.64
|
| Rate for Payer: PHCS Commercial |
$8,967.85
|
| Rate for Payer: United Healthcare All Payer |
$8,220.53
|
|
|
SYN FRAC MGMT FEM SZ 13
|
Facility
|
OP
|
$9,341.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.45 |
| Max. Negotiated Rate |
$8,967.85 |
| Rate for Payer: Aetna Commercial |
$7,192.96
|
| Rate for Payer: Anthem Medicaid |
$3,212.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,286.38
|
| Rate for Payer: Cash Price |
$4,670.76
|
| Rate for Payer: Cigna Commercial |
$7,753.45
|
| Rate for Payer: First Health Commercial |
$8,874.43
|
| Rate for Payer: Humana Commercial |
$7,940.28
|
| Rate for Payer: Humana KY Medicaid |
$3,212.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,245.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,660.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,894.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,277.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,220.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,006.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,473.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,127.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,445.64
|
| Rate for Payer: PHCS Commercial |
$8,967.85
|
| Rate for Payer: United Healthcare All Payer |
$8,220.53
|
|
|
SYN FRAC MGMT FEM SZ 13
|
Facility
|
IP
|
$9,341.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.45 |
| Max. Negotiated Rate |
$8,967.85 |
| Rate for Payer: Aetna Commercial |
$7,192.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,286.38
|
| Rate for Payer: Cash Price |
$4,670.76
|
| Rate for Payer: Cigna Commercial |
$7,753.45
|
| Rate for Payer: First Health Commercial |
$8,874.43
|
| Rate for Payer: Humana Commercial |
$7,940.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,660.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,894.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,220.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,006.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,473.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,127.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,445.64
|
| Rate for Payer: PHCS Commercial |
$8,967.85
|
| Rate for Payer: United Healthcare All Payer |
$8,220.53
|
|
|
SYN HA HO PRESFIT FEM CMP SZ10
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ10
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ11
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ11
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ12
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ12
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ13
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ13
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ14
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ14
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ15
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ15
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ16
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ16
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ17
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ17
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM CMP SZ18
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
