|
UNI EIUS FEM MEDIUM LM/RL
|
Facility
|
IP
|
$11,424.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,427.28 |
| Max. Negotiated Rate |
$10,967.29 |
| Rate for Payer: Aetna Commercial |
$8,796.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,910.92
|
| Rate for Payer: Cash Price |
$5,712.13
|
| Rate for Payer: Cigna Commercial |
$9,482.14
|
| Rate for Payer: First Health Commercial |
$10,853.05
|
| Rate for Payer: Humana Commercial |
$9,710.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,367.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,431.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,427.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,053.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,568.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,139.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,939.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,882.74
|
| Rate for Payer: PHCS Commercial |
$10,967.29
|
| Rate for Payer: United Healthcare All Payer |
$10,053.35
|
|
|
UNI EIUS FEM MEDIUM RM/LL
|
Facility
|
OP
|
$11,424.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,427.28 |
| Max. Negotiated Rate |
$10,967.29 |
| Rate for Payer: Aetna Commercial |
$8,796.68
|
| Rate for Payer: Anthem Medicaid |
$3,928.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,910.92
|
| Rate for Payer: Cash Price |
$5,712.13
|
| Rate for Payer: Cigna Commercial |
$9,482.14
|
| Rate for Payer: First Health Commercial |
$10,853.05
|
| Rate for Payer: Humana Commercial |
$9,710.62
|
| Rate for Payer: Humana KY Medicaid |
$3,928.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,968.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,367.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,431.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,427.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,007.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,053.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,568.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,139.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,939.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,882.74
|
| Rate for Payer: PHCS Commercial |
$10,967.29
|
| Rate for Payer: United Healthcare All Payer |
$10,053.35
|
|
|
UNI EIUS FEM MEDIUM RM/LL
|
Facility
|
IP
|
$11,424.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,427.28 |
| Max. Negotiated Rate |
$10,967.29 |
| Rate for Payer: Aetna Commercial |
$8,796.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,910.92
|
| Rate for Payer: Cash Price |
$5,712.13
|
| Rate for Payer: Cigna Commercial |
$9,482.14
|
| Rate for Payer: First Health Commercial |
$10,853.05
|
| Rate for Payer: Humana Commercial |
$9,710.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,367.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,431.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,427.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,053.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,568.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,139.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,939.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,882.74
|
| Rate for Payer: PHCS Commercial |
$10,967.29
|
| Rate for Payer: United Healthcare All Payer |
$10,053.35
|
|
|
UNI EIUS FEM SMALL LM/RL
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM SMALL LM/RL
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM SMALL RM/LL
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM SMALL RM/LL
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM XLARGE LM/RL
|
Facility
|
IP
|
$11,342.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,402.62 |
| Max. Negotiated Rate |
$10,888.38 |
| Rate for Payer: Aetna Commercial |
$8,733.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,846.81
|
| Rate for Payer: Cash Price |
$5,671.03
|
| Rate for Payer: Cigna Commercial |
$9,413.91
|
| Rate for Payer: First Health Commercial |
$10,774.96
|
| Rate for Payer: Humana Commercial |
$9,640.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,300.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,370.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,402.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,981.01
|
| Rate for Payer: Ohio Health Group HMO |
$8,506.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,073.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,867.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,826.02
|
| Rate for Payer: PHCS Commercial |
$10,888.38
|
| Rate for Payer: United Healthcare All Payer |
$9,981.01
|
|
|
UNI EIUS FEM XLARGE LM/RL
|
Facility
|
OP
|
$11,342.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,402.62 |
| Max. Negotiated Rate |
$10,888.38 |
| Rate for Payer: Aetna Commercial |
$8,733.39
|
| Rate for Payer: Anthem Medicaid |
$3,900.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,846.81
|
| Rate for Payer: Cash Price |
$5,671.03
|
| Rate for Payer: Cigna Commercial |
$9,413.91
|
| Rate for Payer: First Health Commercial |
$10,774.96
|
| Rate for Payer: Humana Commercial |
$9,640.75
|
| Rate for Payer: Humana KY Medicaid |
$3,900.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,940.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,300.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,370.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,402.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,978.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,981.01
|
| Rate for Payer: Ohio Health Group HMO |
$8,506.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,073.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,867.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,826.02
|
| Rate for Payer: PHCS Commercial |
$10,888.38
|
| Rate for Payer: United Healthcare All Payer |
$9,981.01
|
|
|
UNI EIUS FEM XLARGE RM/LL
|
Facility
|
IP
|
$11,342.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,402.62 |
| Max. Negotiated Rate |
$10,888.38 |
| Rate for Payer: Aetna Commercial |
$8,733.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,846.81
|
| Rate for Payer: Cash Price |
$5,671.03
|
| Rate for Payer: Cigna Commercial |
$9,413.91
|
| Rate for Payer: First Health Commercial |
$10,774.96
|
| Rate for Payer: Humana Commercial |
$9,640.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,300.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,370.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,402.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,981.01
|
| Rate for Payer: Ohio Health Group HMO |
$8,506.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,073.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,867.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,826.02
|
| Rate for Payer: PHCS Commercial |
$10,888.38
|
| Rate for Payer: United Healthcare All Payer |
$9,981.01
|
|
|
UNI EIUS FEM XLARGE RM/LL
|
Facility
|
OP
|
$11,342.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,402.62 |
| Max. Negotiated Rate |
$10,888.38 |
| Rate for Payer: Aetna Commercial |
$8,733.39
|
| Rate for Payer: Anthem Medicaid |
$3,900.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,846.81
|
| Rate for Payer: Cash Price |
$5,671.03
|
| Rate for Payer: Cigna Commercial |
$9,413.91
|
| Rate for Payer: First Health Commercial |
$10,774.96
|
| Rate for Payer: Humana Commercial |
$9,640.75
|
| Rate for Payer: Humana KY Medicaid |
$3,900.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,940.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,300.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,370.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,402.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,978.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,981.01
|
| Rate for Payer: Ohio Health Group HMO |
$8,506.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,073.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,867.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,826.02
|
| Rate for Payer: PHCS Commercial |
$10,888.38
|
| Rate for Payer: United Healthcare All Payer |
$9,981.01
|
|
|
UNI EIUS FEM XSMALL LM/RL
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM XSMALL LM/RL
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM XSMALL RM/LL
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM XSMALL RM/LL
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS TIB LARGE 10MM LM/RL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 10MM LM/RL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 10MM RM/LL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 10MM RM/LL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 12MM LM/RL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 12MM LM/RL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 12MM RM/LL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 12MM RM/LL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB LARGE 8MM LM/RL
|
Facility
|
IP
|
$8,977.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.17 |
| Max. Negotiated Rate |
$8,618.15 |
| Rate for Payer: Aetna Commercial |
$6,912.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,002.25
|
| Rate for Payer: Cash Price |
$4,488.62
|
| Rate for Payer: Cigna Commercial |
$7,451.11
|
| Rate for Payer: First Health Commercial |
$8,528.38
|
| Rate for Payer: Humana Commercial |
$7,630.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,361.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,625.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,899.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,732.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,181.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,810.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,194.30
|
| Rate for Payer: PHCS Commercial |
$8,618.15
|
| Rate for Payer: United Healthcare All Payer |
$7,899.97
|
|
|
UNI EIUS TIB LARGE 8MM LM/RL
|
Facility
|
OP
|
$8,977.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.17 |
| Max. Negotiated Rate |
$8,618.15 |
| Rate for Payer: Aetna Commercial |
$6,912.47
|
| Rate for Payer: Anthem Medicaid |
$3,087.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,002.25
|
| Rate for Payer: Cash Price |
$4,488.62
|
| Rate for Payer: Cigna Commercial |
$7,451.11
|
| Rate for Payer: First Health Commercial |
$8,528.38
|
| Rate for Payer: Humana Commercial |
$7,630.65
|
| Rate for Payer: Humana KY Medicaid |
$3,087.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,118.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,361.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,625.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,899.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,732.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,181.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,810.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,194.30
|
| Rate for Payer: PHCS Commercial |
$8,618.15
|
| Rate for Payer: United Healthcare All Payer |
$7,899.97
|
|
