|
UNI 14/16 TPR SLV +8
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
UNI BR IMPLANT REM-INTACT OFC
|
Professional
|
Both
|
$1,000.00
|
|
| Hospital Charge Code |
22200720
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
UNI BR IMPLANT REM-RUPT OFC
|
Professional
|
Both
|
$1,000.00
|
|
| Hospital Charge Code |
22200721
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
UNICORTICAL TF SHAFT 3.5MM
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.95 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.65
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
UNICORTICAL TF SHAFT 3.5MM
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.95 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem Medicaid |
$1,105.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Humana KY Medicaid |
$1,105.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.65
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
UNI EIUS FEM LARGE LM/RL
|
Facility
|
IP
|
$12,065.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.56 |
| Max. Negotiated Rate |
$11,583.21 |
| Rate for Payer: Aetna Commercial |
$9,290.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.36
|
| Rate for Payer: Cash Price |
$6,032.92
|
| Rate for Payer: Cigna Commercial |
$10,014.65
|
| Rate for Payer: First Health Commercial |
$11,462.55
|
| Rate for Payer: Humana Commercial |
$10,255.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,893.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,617.94
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,413.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,568.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,740.41
|
| Rate for Payer: PHCS Commercial |
$11,583.21
|
| Rate for Payer: United Healthcare All Payer |
$10,617.94
|
|
|
UNI EIUS FEM LARGE LM/RL
|
Facility
|
OP
|
$12,065.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.56 |
| Max. Negotiated Rate |
$11,583.21 |
| Rate for Payer: Aetna Commercial |
$9,290.70
|
| Rate for Payer: Anthem Medicaid |
$4,149.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,411.36
|
| Rate for Payer: Cash Price |
$6,032.92
|
| Rate for Payer: Cigna Commercial |
$10,014.65
|
| Rate for Payer: First Health Commercial |
$11,462.55
|
| Rate for Payer: Humana Commercial |
$10,255.96
|
| Rate for Payer: Humana KY Medicaid |
$4,149.44
|
| Rate for Payer: Kentucky WC Medicaid |
$4,191.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,893.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,904.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,619.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,232.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,617.94
|
| Rate for Payer: Ohio Health Group HMO |
$9,049.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,413.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,568.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,740.41
|
| Rate for Payer: PHCS Commercial |
$11,583.21
|
| Rate for Payer: United Healthcare All Payer |
$10,617.94
|
|
|
UNI EIUS FEM LARGE RM/LL
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM LARGE RM/LL
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM MEDIUM LM/RL
|
Facility
|
IP
|
$11,181.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.54 |
| Max. Negotiated Rate |
$10,733.84 |
| Rate for Payer: Aetna Commercial |
$8,609.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,721.24
|
| Rate for Payer: Cash Price |
$5,590.54
|
| Rate for Payer: Cigna Commercial |
$9,280.30
|
| Rate for Payer: First Health Commercial |
$10,622.03
|
| Rate for Payer: Humana Commercial |
$9,503.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,168.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,251.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,839.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,466.13
|
| Rate for Payer: PHCS Commercial |
$10,733.84
|
| Rate for Payer: United Healthcare All Payer |
$9,839.35
|
|
|
UNI EIUS FEM MEDIUM LM/RL
|
Facility
|
OP
|
$11,181.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.54 |
| Max. Negotiated Rate |
$10,733.84 |
| Rate for Payer: Aetna Commercial |
$8,609.43
|
| Rate for Payer: Anthem Medicaid |
$3,845.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,721.24
|
| Rate for Payer: Cash Price |
$5,590.54
|
| Rate for Payer: Cigna Commercial |
$9,280.30
|
| Rate for Payer: First Health Commercial |
$10,622.03
|
| Rate for Payer: Humana Commercial |
$9,503.92
|
| Rate for Payer: Humana KY Medicaid |
$3,845.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,168.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,251.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,839.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,466.13
|
| Rate for Payer: PHCS Commercial |
$10,733.84
|
| Rate for Payer: United Healthcare All Payer |
$9,839.35
|
|
|
UNI EIUS FEM MEDIUM RM/LL
|
Facility
|
OP
|
$11,181.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.54 |
| Max. Negotiated Rate |
$10,733.84 |
| Rate for Payer: Aetna Commercial |
$8,609.43
|
| Rate for Payer: Anthem Medicaid |
$3,845.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,721.24
|
| Rate for Payer: Cash Price |
$5,590.54
|
| Rate for Payer: Cigna Commercial |
$9,280.30
|
| Rate for Payer: First Health Commercial |
$10,622.03
|
| Rate for Payer: Humana Commercial |
$9,503.92
|
| Rate for Payer: Humana KY Medicaid |
$3,845.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,168.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,251.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,839.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,466.13
|
| Rate for Payer: PHCS Commercial |
$10,733.84
|
| Rate for Payer: United Healthcare All Payer |
$9,839.35
|
|
|
UNI EIUS FEM MEDIUM RM/LL
|
Facility
|
IP
|
$11,181.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.54 |
| Max. Negotiated Rate |
$10,733.84 |
| Rate for Payer: Aetna Commercial |
$8,609.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,721.24
|
| Rate for Payer: Cash Price |
$5,590.54
|
| Rate for Payer: Cigna Commercial |
$9,280.30
|
| Rate for Payer: First Health Commercial |
$10,622.03
|
| Rate for Payer: Humana Commercial |
$9,503.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,168.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,251.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,839.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,466.13
|
| Rate for Payer: PHCS Commercial |
$10,733.84
|
| Rate for Payer: United Healthcare All Payer |
$9,839.35
|
|
|
UNI EIUS FEM SMALL LM/RL
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM SMALL LM/RL
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM SMALL RM/LL
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM SMALL RM/LL
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM XLARGE LM/RL
|
Facility
|
IP
|
$11,099.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.91 |
| Max. Negotiated Rate |
$10,655.35 |
| Rate for Payer: Aetna Commercial |
$8,546.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,657.47
|
| Rate for Payer: Cash Price |
$5,549.66
|
| Rate for Payer: Cigna Commercial |
$9,212.44
|
| Rate for Payer: First Health Commercial |
$10,544.35
|
| Rate for Payer: Humana Commercial |
$9,434.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,101.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,191.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,767.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,324.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,219.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,440.79
|
| Rate for Payer: PHCS Commercial |
$10,655.35
|
| Rate for Payer: United Healthcare All Payer |
$9,767.40
|
|
|
UNI EIUS FEM XLARGE LM/RL
|
Facility
|
OP
|
$11,099.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.91 |
| Max. Negotiated Rate |
$10,655.35 |
| Rate for Payer: Aetna Commercial |
$8,546.48
|
| Rate for Payer: Anthem Medicaid |
$3,817.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,657.47
|
| Rate for Payer: Cash Price |
$5,549.66
|
| Rate for Payer: Cigna Commercial |
$9,212.44
|
| Rate for Payer: First Health Commercial |
$10,544.35
|
| Rate for Payer: Humana Commercial |
$9,434.42
|
| Rate for Payer: Humana KY Medicaid |
$3,817.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,101.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,191.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,893.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,767.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,324.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,219.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,440.79
|
| Rate for Payer: PHCS Commercial |
$10,655.35
|
| Rate for Payer: United Healthcare All Payer |
$9,767.40
|
|
|
UNI EIUS FEM XLARGE RM/LL
|
Facility
|
OP
|
$11,099.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.91 |
| Max. Negotiated Rate |
$10,655.35 |
| Rate for Payer: Aetna Commercial |
$8,546.48
|
| Rate for Payer: Anthem Medicaid |
$3,817.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,657.47
|
| Rate for Payer: Cash Price |
$5,549.66
|
| Rate for Payer: Cigna Commercial |
$9,212.44
|
| Rate for Payer: First Health Commercial |
$10,544.35
|
| Rate for Payer: Humana Commercial |
$9,434.42
|
| Rate for Payer: Humana KY Medicaid |
$3,817.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,101.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,191.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,893.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,767.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,324.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,219.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,440.79
|
| Rate for Payer: PHCS Commercial |
$10,655.35
|
| Rate for Payer: United Healthcare All Payer |
$9,767.40
|
|
|
UNI EIUS FEM XLARGE RM/LL
|
Facility
|
IP
|
$11,099.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.91 |
| Max. Negotiated Rate |
$10,655.35 |
| Rate for Payer: Aetna Commercial |
$8,546.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,657.47
|
| Rate for Payer: Cash Price |
$5,549.66
|
| Rate for Payer: Cigna Commercial |
$9,212.44
|
| Rate for Payer: First Health Commercial |
$10,544.35
|
| Rate for Payer: Humana Commercial |
$9,434.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,101.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,191.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,767.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,324.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,219.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,440.79
|
| Rate for Payer: PHCS Commercial |
$10,655.35
|
| Rate for Payer: United Healthcare All Payer |
$9,767.40
|
|
|
UNI EIUS FEM XSMALL LM/RL
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM XSMALL LM/RL
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM XSMALL RM/LL
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
UNI EIUS FEM XSMALL RM/LL
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
