|
FEM C/R GNS II SZ6 RT
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM C/R GNS II SZ6 RT
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM C/R GNS II SZ7 RT
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM C/R GNS II SZ7 RT
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM DIS EDG HK LGN SZ 3 5MM
|
Facility
|
IP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 3 5MM
|
Facility
|
OP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem Medicaid |
$2,948.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Humana KY Medicaid |
$2,948.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,978.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,007.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 4 10MM
|
Facility
|
OP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem Medicaid |
$2,948.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Humana KY Medicaid |
$2,948.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,978.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,007.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 4 10MM
|
Facility
|
IP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 4 15MM
|
Facility
|
OP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem Medicaid |
$2,948.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Humana KY Medicaid |
$2,948.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,978.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,007.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 4 15MM
|
Facility
|
IP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 4 5MM
|
Facility
|
OP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem Medicaid |
$2,948.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Humana KY Medicaid |
$2,948.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,978.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,007.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 4 5MM
|
Facility
|
IP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 5 10MM
|
Facility
|
IP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 5 10MM
|
Facility
|
OP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem Medicaid |
$2,948.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Humana KY Medicaid |
$2,948.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,978.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,007.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 5 15MM
|
Facility
|
IP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 5 15MM
|
Facility
|
OP
|
$8,574.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.66 |
| Max. Negotiated Rate |
$8,231.33 |
| Rate for Payer: Aetna Commercial |
$6,602.21
|
| Rate for Payer: Anthem Medicaid |
$2,948.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,687.95
|
| Rate for Payer: Cash Price |
$4,287.15
|
| Rate for Payer: Cigna Commercial |
$7,116.67
|
| Rate for Payer: First Health Commercial |
$8,145.58
|
| Rate for Payer: Humana Commercial |
$7,288.16
|
| Rate for Payer: Humana KY Medicaid |
$2,948.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,978.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,030.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,327.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,007.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,545.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,430.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,714.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,114.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.03
|
| Rate for Payer: PHCS Commercial |
$8,231.33
|
| Rate for Payer: United Healthcare All Payer |
$7,545.38
|
|
|
FEM DIS EDG HK LGN SZ 6 10MM
|
Facility
|
OP
|
$8,191.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.84 |
| Max. Negotiated Rate |
$7,863.41 |
| Rate for Payer: Aetna Commercial |
$6,307.11
|
| Rate for Payer: Anthem Medicaid |
$2,816.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,389.02
|
| Rate for Payer: Cash Price |
$4,095.52
|
| Rate for Payer: Cigna Commercial |
$6,798.57
|
| Rate for Payer: First Health Commercial |
$7,781.50
|
| Rate for Payer: Humana Commercial |
$6,962.39
|
| Rate for Payer: Humana KY Medicaid |
$2,816.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,845.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,873.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,208.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,143.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.23
|
| Rate for Payer: PHCS Commercial |
$7,863.41
|
| Rate for Payer: United Healthcare All Payer |
$7,208.12
|
|
|
FEM DIS EDG HK LGN SZ 6 10MM
|
Facility
|
IP
|
$8,191.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.84 |
| Max. Negotiated Rate |
$7,863.41 |
| Rate for Payer: Aetna Commercial |
$6,307.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,389.02
|
| Rate for Payer: Cash Price |
$4,095.52
|
| Rate for Payer: Cigna Commercial |
$6,798.57
|
| Rate for Payer: First Health Commercial |
$7,781.50
|
| Rate for Payer: Humana Commercial |
$6,962.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,208.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,143.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.23
|
| Rate for Payer: PHCS Commercial |
$7,863.41
|
| Rate for Payer: United Healthcare All Payer |
$7,208.12
|
|
|
FEM DIS EDG HK LGN SZ 6 15MM
|
Facility
|
IP
|
$8,191.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.84 |
| Max. Negotiated Rate |
$7,863.41 |
| Rate for Payer: Aetna Commercial |
$6,307.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,389.02
|
| Rate for Payer: Cash Price |
$4,095.52
|
| Rate for Payer: Cigna Commercial |
$6,798.57
|
| Rate for Payer: First Health Commercial |
$7,781.50
|
| Rate for Payer: Humana Commercial |
$6,962.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,208.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,143.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.23
|
| Rate for Payer: PHCS Commercial |
$7,863.41
|
| Rate for Payer: United Healthcare All Payer |
$7,208.12
|
|
|
FEM DIS EDG HK LGN SZ 6 15MM
|
Facility
|
OP
|
$8,191.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.84 |
| Max. Negotiated Rate |
$7,863.41 |
| Rate for Payer: Aetna Commercial |
$6,307.11
|
| Rate for Payer: Anthem Medicaid |
$2,816.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,389.02
|
| Rate for Payer: Cash Price |
$4,095.52
|
| Rate for Payer: Cigna Commercial |
$6,798.57
|
| Rate for Payer: First Health Commercial |
$7,781.50
|
| Rate for Payer: Humana Commercial |
$6,962.39
|
| Rate for Payer: Humana KY Medicaid |
$2,816.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,845.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,873.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,208.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,143.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.23
|
| Rate for Payer: PHCS Commercial |
$7,863.41
|
| Rate for Payer: United Healthcare All Payer |
$7,208.12
|
|
|
FEM DIS EDG HK LGN SZ 6 5MM
|
Facility
|
OP
|
$8,191.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.84 |
| Max. Negotiated Rate |
$7,863.41 |
| Rate for Payer: Aetna Commercial |
$6,307.11
|
| Rate for Payer: Anthem Medicaid |
$2,816.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,389.02
|
| Rate for Payer: Cash Price |
$4,095.52
|
| Rate for Payer: Cigna Commercial |
$6,798.57
|
| Rate for Payer: First Health Commercial |
$7,781.50
|
| Rate for Payer: Humana Commercial |
$6,962.39
|
| Rate for Payer: Humana KY Medicaid |
$2,816.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,845.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,873.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,208.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,143.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.23
|
| Rate for Payer: PHCS Commercial |
$7,863.41
|
| Rate for Payer: United Healthcare All Payer |
$7,208.12
|
|
|
FEM DIS EDG HK LGN SZ 6 5MM
|
Facility
|
IP
|
$8,191.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.84 |
| Max. Negotiated Rate |
$7,863.41 |
| Rate for Payer: Aetna Commercial |
$6,307.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,389.02
|
| Rate for Payer: Cash Price |
$4,095.52
|
| Rate for Payer: Cigna Commercial |
$6,798.57
|
| Rate for Payer: First Health Commercial |
$7,781.50
|
| Rate for Payer: Humana Commercial |
$6,962.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,716.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,457.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,208.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,143.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,539.23
|
| Rate for Payer: PHCS Commercial |
$7,863.41
|
| Rate for Payer: United Healthcare All Payer |
$7,208.12
|
|
|
FEM DIS EDG HK LGN SZ 7 10MM
|
Facility
|
IP
|
$7,897.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,026.64 |
| Max. Negotiated Rate |
$7,581.34 |
| Rate for Payer: Aetna Commercial |
$6,080.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,159.84
|
| Rate for Payer: Cash Price |
$3,948.61
|
| Rate for Payer: Cigna Commercial |
$6,554.70
|
| Rate for Payer: First Health Commercial |
$7,502.37
|
| Rate for Payer: Humana Commercial |
$6,712.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,475.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,369.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,949.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,922.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,579.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,448.14
|
| Rate for Payer: PHCS Commercial |
$7,581.34
|
| Rate for Payer: United Healthcare All Payer |
$6,949.56
|
|
|
FEM DIS EDG HK LGN SZ 7 10MM
|
Facility
|
OP
|
$7,897.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,026.64 |
| Max. Negotiated Rate |
$7,581.34 |
| Rate for Payer: Aetna Commercial |
$6,080.87
|
| Rate for Payer: Anthem Medicaid |
$2,715.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,159.84
|
| Rate for Payer: Cash Price |
$3,948.61
|
| Rate for Payer: Cigna Commercial |
$6,554.70
|
| Rate for Payer: First Health Commercial |
$7,502.37
|
| Rate for Payer: Humana Commercial |
$6,712.65
|
| Rate for Payer: Humana KY Medicaid |
$2,715.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,743.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,475.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,369.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,770.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,949.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,922.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,579.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,448.14
|
| Rate for Payer: PHCS Commercial |
$7,581.34
|
| Rate for Payer: United Healthcare All Payer |
$6,949.56
|
|
|
FEM DIS EDG HK LGN SZ 7 15MM
|
Facility
|
IP
|
$7,897.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,026.64 |
| Max. Negotiated Rate |
$7,581.34 |
| Rate for Payer: Aetna Commercial |
$6,080.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,159.84
|
| Rate for Payer: Cash Price |
$3,948.61
|
| Rate for Payer: Cigna Commercial |
$6,554.70
|
| Rate for Payer: First Health Commercial |
$7,502.37
|
| Rate for Payer: Humana Commercial |
$6,712.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,475.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,828.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,369.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,949.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,922.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,579.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,448.14
|
| Rate for Payer: PHCS Commercial |
$7,581.34
|
| Rate for Payer: United Healthcare All Payer |
$6,949.56
|
|
