|
CR FLEX ART SUR C-H/5 6 GRN 14
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/7 10 BLU 1
|
Facility
|
OP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,453.51
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,453.51
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
|
|
CR FLEX ART SUR C-H/7 10 BLU 1
|
Facility
|
IP
|
$7,134.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.47 |
| Max. Negotiated Rate |
$6,849.00 |
| Rate for Payer: Aetna Commercial |
$5,493.47
|
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,564.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,567.19
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$5,921.54
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: First Health Commercial |
$6,777.66
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana Commercial |
$6,064.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,350.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.66
|
| Rate for Payer: PHCS Commercial |
$6,849.00
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,278.25
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
CR-FLEX GSF POROUS FEM C LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C LT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C LT -
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C LT -
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C RT -
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM C RT -
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D LT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D LT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D LT -
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D LT -
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D RT
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D RT
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D RT -
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM D RT -
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM E LT
|
Facility
|
IP
|
$21,790.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.80 |
| Max. Negotiated Rate |
$20,919.12 |
| Rate for Payer: Aetna Commercial |
$16,778.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,996.78
|
| Rate for Payer: Cash Price |
$10,895.38
|
| Rate for Payer: Cigna Commercial |
$18,086.32
|
| Rate for Payer: First Health Commercial |
$20,701.21
|
| Rate for Payer: Humana Commercial |
$18,522.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,868.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,537.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,175.86
|
| Rate for Payer: Ohio Health Group HMO |
$16,343.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,832.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,755.13
|
| Rate for Payer: PHCS Commercial |
$20,919.12
|
| Rate for Payer: United Healthcare All Payer |
$19,175.86
|
|
|
CR-FLEX GSF POROUS FEM E LT
|
Facility
|
OP
|
$21,790.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.80 |
| Max. Negotiated Rate |
$20,919.12 |
| Rate for Payer: Aetna Commercial |
$16,778.88
|
| Rate for Payer: Anthem Medicaid |
$7,493.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,996.78
|
| Rate for Payer: Cash Price |
$10,895.38
|
| Rate for Payer: Cigna Commercial |
$18,086.32
|
| Rate for Payer: First Health Commercial |
$20,701.21
|
| Rate for Payer: Humana Commercial |
$18,522.14
|
| Rate for Payer: Humana KY Medicaid |
$7,493.84
|
| Rate for Payer: Kentucky WC Medicaid |
$7,570.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,868.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,537.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,644.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,175.86
|
| Rate for Payer: Ohio Health Group HMO |
$16,343.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,832.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,755.13
|
| Rate for Payer: PHCS Commercial |
$20,919.12
|
| Rate for Payer: United Healthcare All Payer |
$19,175.86
|
|
|
CR-FLEX GSF POROUS FEM E LT -
|
Facility
|
OP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem Medicaid |
$7,613.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Humana KY Medicaid |
$7,613.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,690.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,765.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM E LT -
|
Facility
|
IP
|
$22,137.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,877.88 |
| Max. Negotiated Rate |
$21,252.00 |
| Rate for Payer: Aetna Commercial |
$17,045.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,267.25
|
| Rate for Payer: Cash Price |
$11,068.75
|
| Rate for Payer: Cigna Commercial |
$18,374.12
|
| Rate for Payer: First Health Commercial |
$21,030.62
|
| Rate for Payer: Humana Commercial |
$18,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,337.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,481.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,862.62
|
| Rate for Payer: PHCS Commercial |
$21,252.00
|
| Rate for Payer: United Healthcare All Payer |
$19,481.00
|
|
|
CR-FLEX GSF POROUS FEM E RT
|
Facility
|
IP
|
$21,790.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.80 |
| Max. Negotiated Rate |
$20,919.12 |
| Rate for Payer: Aetna Commercial |
$16,778.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,996.78
|
| Rate for Payer: Cash Price |
$10,895.38
|
| Rate for Payer: Cigna Commercial |
$18,086.32
|
| Rate for Payer: First Health Commercial |
$20,701.21
|
| Rate for Payer: Humana Commercial |
$18,522.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,868.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,537.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,175.86
|
| Rate for Payer: Ohio Health Group HMO |
$16,343.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,832.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,755.13
|
| Rate for Payer: PHCS Commercial |
$20,919.12
|
| Rate for Payer: United Healthcare All Payer |
$19,175.86
|
|
|
CR-FLEX GSF POROUS FEM E RT
|
Facility
|
OP
|
$21,790.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.80 |
| Max. Negotiated Rate |
$20,919.12 |
| Rate for Payer: Aetna Commercial |
$16,778.88
|
| Rate for Payer: Anthem Medicaid |
$7,493.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,996.78
|
| Rate for Payer: Cash Price |
$10,895.38
|
| Rate for Payer: Cigna Commercial |
$18,086.32
|
| Rate for Payer: First Health Commercial |
$20,701.21
|
| Rate for Payer: Humana Commercial |
$18,522.14
|
| Rate for Payer: Humana KY Medicaid |
$7,493.84
|
| Rate for Payer: Kentucky WC Medicaid |
$7,570.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,868.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,081.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,537.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,644.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,175.86
|
| Rate for Payer: Ohio Health Group HMO |
$16,343.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,832.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,755.13
|
| Rate for Payer: PHCS Commercial |
$20,919.12
|
| Rate for Payer: United Healthcare All Payer |
$19,175.86
|
|
