|
CR-FLEX GSF PRECOAT FEM D LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM D LT -
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM D LT -
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM D RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM D RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM D RT -
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM D RT -
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E LT -
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E LT -
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E RT -
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM E RT -
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F LT -
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F LT -
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F RT -
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM F RT -
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM G LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
CR-FLEX GSF PRECOAT FEM G LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
