|
FEM DIS EDG HK LGN SZ 7 15MM
|
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 20M
|
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 20M
|
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 5MM
|
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 5MM
|
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 W/P MAK OSS 5CM L
|
Facility
|
IP
|
$71,944.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,352.72 |
| Max. Negotiated Rate |
$69,066.24 |
| Rate for Payer: Aetna Commercial |
$55,396.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,116.32
|
| Rate for Payer: Cash Price |
$35,972.00
|
| Rate for Payer: Cigna Commercial |
$59,713.52
|
| Rate for Payer: First Health Commercial |
$68,346.80
|
| Rate for Payer: Humana Commercial |
$61,152.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,994.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,094.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,583.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,310.72
|
| Rate for Payer: Ohio Health Group HMO |
$53,958.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,388.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,352.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,302.64
|
| Rate for Payer: PHCS Commercial |
$69,066.24
|
| Rate for Payer: United Healthcare All Payer |
$63,310.72
|
|
|
FEM DIS W/P MAK OSS 5CM L
|
Facility
|
OP
|
$71,944.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,352.72 |
| Max. Negotiated Rate |
$69,066.24 |
| Rate for Payer: Aetna Commercial |
$55,396.88
|
| Rate for Payer: Anthem Medicaid |
$24,741.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,116.32
|
| Rate for Payer: Cash Price |
$35,972.00
|
| Rate for Payer: Cigna Commercial |
$59,713.52
|
| Rate for Payer: First Health Commercial |
$68,346.80
|
| Rate for Payer: Humana Commercial |
$61,152.40
|
| Rate for Payer: Humana KY Medicaid |
$24,741.54
|
| Rate for Payer: Kentucky WC Medicaid |
$24,993.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,994.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,094.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,583.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,237.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,310.72
|
| Rate for Payer: Ohio Health Group HMO |
$53,958.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,388.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,352.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,302.64
|
| Rate for Payer: PHCS Commercial |
$69,066.24
|
| Rate for Payer: United Healthcare All Payer |
$63,310.72
|
|
|
FEM DIS W/P MAK OSS 5CM R
|
Facility
|
OP
|
$71,944.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,352.72 |
| Max. Negotiated Rate |
$69,066.24 |
| Rate for Payer: Aetna Commercial |
$55,396.88
|
| Rate for Payer: Anthem Medicaid |
$24,741.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,116.32
|
| Rate for Payer: Cash Price |
$35,972.00
|
| Rate for Payer: Cigna Commercial |
$59,713.52
|
| Rate for Payer: First Health Commercial |
$68,346.80
|
| Rate for Payer: Humana Commercial |
$61,152.40
|
| Rate for Payer: Humana KY Medicaid |
$24,741.54
|
| Rate for Payer: Kentucky WC Medicaid |
$24,993.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,994.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,094.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,583.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,237.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,310.72
|
| Rate for Payer: Ohio Health Group HMO |
$53,958.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,388.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,352.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,302.64
|
| Rate for Payer: PHCS Commercial |
$69,066.24
|
| Rate for Payer: United Healthcare All Payer |
$63,310.72
|
|
|
FEM DIS W/P MAK OSS 5CM R
|
Facility
|
IP
|
$71,944.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,352.72 |
| Max. Negotiated Rate |
$69,066.24 |
| Rate for Payer: Aetna Commercial |
$55,396.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,116.32
|
| Rate for Payer: Cash Price |
$35,972.00
|
| Rate for Payer: Cigna Commercial |
$59,713.52
|
| Rate for Payer: First Health Commercial |
$68,346.80
|
| Rate for Payer: Humana Commercial |
$61,152.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,994.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,094.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,583.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,310.72
|
| Rate for Payer: Ohio Health Group HMO |
$53,958.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,388.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,352.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,302.64
|
| Rate for Payer: PHCS Commercial |
$69,066.24
|
| Rate for Payer: United Healthcare All Payer |
$63,310.72
|
|
|
FEM DIS W/P MAK OSS 7CM E L
|
Facility
|
OP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem Medicaid |
$25,353.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Humana KY Medicaid |
$25,353.63
|
| Rate for Payer: Kentucky WC Medicaid |
$25,611.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM DIS W/P MAK OSS 7CM E L
|
Facility
|
IP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM DIS W/P MAK OSS 7CM E R
|
Facility
|
IP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM DIS W/P MAK OSS 7CM E R
|
Facility
|
OP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem Medicaid |
$25,353.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Humana KY Medicaid |
$25,353.63
|
| Rate for Payer: Kentucky WC Medicaid |
$25,611.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM DIS W/P MAK OSS 8.5CM E L
|
Facility
|
OP
|
$72,877.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$69,962.04 |
| Rate for Payer: Aetna Commercial |
$56,115.38
|
| Rate for Payer: Anthem Medicaid |
$25,062.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,844.15
|
| Rate for Payer: Cash Price |
$36,438.56
|
| Rate for Payer: Cigna Commercial |
$60,488.01
|
| Rate for Payer: First Health Commercial |
$69,233.26
|
| Rate for Payer: Humana Commercial |
$61,945.55
|
| Rate for Payer: Humana KY Medicaid |
$25,062.44
|
| Rate for Payer: Kentucky WC Medicaid |
$25,317.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,759.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,783.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,863.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,565.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,131.87
|
| Rate for Payer: Ohio Health Group HMO |
$54,657.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,575.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,474.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,591.91
|
| Rate for Payer: PHCS Commercial |
$69,962.04
|
| Rate for Payer: United Healthcare All Payer |
$64,131.87
|
|
|
FEM DIS W/P MAK OSS 8.5CM E L
|
Facility
|
IP
|
$72,877.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$69,962.04 |
| Rate for Payer: Aetna Commercial |
$56,115.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,844.15
|
| Rate for Payer: Cash Price |
$36,438.56
|
| Rate for Payer: Cigna Commercial |
$60,488.01
|
| Rate for Payer: First Health Commercial |
$69,233.26
|
| Rate for Payer: Humana Commercial |
$61,945.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,759.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,783.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,863.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,131.87
|
| Rate for Payer: Ohio Health Group HMO |
$54,657.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,575.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,474.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,591.91
|
| Rate for Payer: PHCS Commercial |
$69,962.04
|
| Rate for Payer: United Healthcare All Payer |
$64,131.87
|
|
|
FEM DIS W/P MAK OSS 8.5CM E R
|
Facility
|
IP
|
$72,877.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$69,962.04 |
| Rate for Payer: Aetna Commercial |
$56,115.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,844.15
|
| Rate for Payer: Cash Price |
$36,438.56
|
| Rate for Payer: Cigna Commercial |
$60,488.01
|
| Rate for Payer: First Health Commercial |
$69,233.26
|
| Rate for Payer: Humana Commercial |
$61,945.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,759.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,783.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,863.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,131.87
|
| Rate for Payer: Ohio Health Group HMO |
$54,657.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,575.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,474.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,591.91
|
| Rate for Payer: PHCS Commercial |
$69,962.04
|
| Rate for Payer: United Healthcare All Payer |
$64,131.87
|
|
|
FEM DIS W/P MAK OSS 8.5CM E R
|
Facility
|
OP
|
$72,877.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$69,962.04 |
| Rate for Payer: Aetna Commercial |
$56,115.38
|
| Rate for Payer: Anthem Medicaid |
$25,062.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,844.15
|
| Rate for Payer: Cash Price |
$36,438.56
|
| Rate for Payer: Cigna Commercial |
$60,488.01
|
| Rate for Payer: First Health Commercial |
$69,233.26
|
| Rate for Payer: Humana Commercial |
$61,945.55
|
| Rate for Payer: Humana KY Medicaid |
$25,062.44
|
| Rate for Payer: Kentucky WC Medicaid |
$25,317.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,759.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,783.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,863.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,565.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,131.87
|
| Rate for Payer: Ohio Health Group HMO |
$54,657.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,575.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,474.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,591.91
|
| Rate for Payer: PHCS Commercial |
$69,962.04
|
| Rate for Payer: United Healthcare All Payer |
$64,131.87
|
|
|
FEM DIS W/P MAK OSS 8.5CM R
|
Facility
|
OP
|
$72,877.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$69,962.04 |
| Rate for Payer: Aetna Commercial |
$56,115.38
|
| Rate for Payer: Anthem Medicaid |
$25,062.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,844.15
|
| Rate for Payer: Cash Price |
$36,438.56
|
| Rate for Payer: Cigna Commercial |
$60,488.01
|
| Rate for Payer: First Health Commercial |
$69,233.26
|
| Rate for Payer: Humana Commercial |
$61,945.55
|
| Rate for Payer: Humana KY Medicaid |
$25,062.44
|
| Rate for Payer: Kentucky WC Medicaid |
$25,317.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,759.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,783.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,863.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,565.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,131.87
|
| Rate for Payer: Ohio Health Group HMO |
$54,657.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,575.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,474.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,591.91
|
| Rate for Payer: PHCS Commercial |
$69,962.04
|
| Rate for Payer: United Healthcare All Payer |
$64,131.87
|
|
|
FEM DIS W/P MAK OSS 8.5CM R
|
Facility
|
IP
|
$72,877.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,474.03 |
| Max. Negotiated Rate |
$69,962.04 |
| Rate for Payer: Aetna Commercial |
$56,115.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,844.15
|
| Rate for Payer: Cash Price |
$36,438.56
|
| Rate for Payer: Cigna Commercial |
$60,488.01
|
| Rate for Payer: First Health Commercial |
$69,233.26
|
| Rate for Payer: Humana Commercial |
$61,945.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,759.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,783.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,863.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,131.87
|
| Rate for Payer: Ohio Health Group HMO |
$54,657.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,575.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,474.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,591.91
|
| Rate for Payer: PHCS Commercial |
$69,962.04
|
| Rate for Payer: United Healthcare All Payer |
$64,131.87
|
|
|
FEM DIS W/P MAK RS OSS 5CM L
|
Facility
|
IP
|
$68,410.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,893.33 |
| Max. Negotiated Rate |
$65,673.83 |
| Rate for Payer: Aetna Commercial |
$52,675.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,359.99
|
| Rate for Payer: Cash Price |
$34,205.12
|
| Rate for Payer: Cigna Commercial |
$56,780.50
|
| Rate for Payer: First Health Commercial |
$64,989.73
|
| Rate for Payer: Humana Commercial |
$58,148.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,096.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,486.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,523.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,201.01
|
| Rate for Payer: Ohio Health Group HMO |
$51,307.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,682.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,893.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,207.17
|
| Rate for Payer: PHCS Commercial |
$65,673.83
|
| Rate for Payer: United Healthcare All Payer |
$60,201.01
|
|
|
FEM DIS W/P MAK RS OSS 5CM L
|
Facility
|
OP
|
$68,410.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,893.33 |
| Max. Negotiated Rate |
$65,673.83 |
| Rate for Payer: Aetna Commercial |
$52,675.88
|
| Rate for Payer: Anthem Medicaid |
$23,526.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,359.99
|
| Rate for Payer: Cash Price |
$34,205.12
|
| Rate for Payer: Cigna Commercial |
$56,780.50
|
| Rate for Payer: First Health Commercial |
$64,989.73
|
| Rate for Payer: Humana Commercial |
$58,148.70
|
| Rate for Payer: Humana KY Medicaid |
$23,526.28
|
| Rate for Payer: Kentucky WC Medicaid |
$23,765.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,096.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,486.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,523.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,998.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,201.01
|
| Rate for Payer: Ohio Health Group HMO |
$51,307.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,682.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,893.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,207.17
|
| Rate for Payer: PHCS Commercial |
$65,673.83
|
| Rate for Payer: United Healthcare All Payer |
$60,201.01
|
|
|
FEM DIS W/P MAK RS OSS 5CM R
|
Facility
|
IP
|
$68,410.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,893.33 |
| Max. Negotiated Rate |
$65,673.83 |
| Rate for Payer: Aetna Commercial |
$52,675.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,359.99
|
| Rate for Payer: Cash Price |
$34,205.12
|
| Rate for Payer: Cigna Commercial |
$56,780.50
|
| Rate for Payer: First Health Commercial |
$64,989.73
|
| Rate for Payer: Humana Commercial |
$58,148.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,096.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,486.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,523.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,201.01
|
| Rate for Payer: Ohio Health Group HMO |
$51,307.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,682.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,893.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,207.17
|
| Rate for Payer: PHCS Commercial |
$65,673.83
|
| Rate for Payer: United Healthcare All Payer |
$60,201.01
|
|
|
FEM DIS W/P MAK RS OSS 5CM R
|
Facility
|
OP
|
$68,410.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,893.33 |
| Max. Negotiated Rate |
$65,673.83 |
| Rate for Payer: Aetna Commercial |
$52,675.88
|
| Rate for Payer: Anthem Medicaid |
$23,526.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,359.99
|
| Rate for Payer: Cash Price |
$34,205.12
|
| Rate for Payer: Cigna Commercial |
$56,780.50
|
| Rate for Payer: First Health Commercial |
$64,989.73
|
| Rate for Payer: Humana Commercial |
$58,148.70
|
| Rate for Payer: Humana KY Medicaid |
$23,526.28
|
| Rate for Payer: Kentucky WC Medicaid |
$23,765.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,096.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,486.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,523.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,998.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,201.01
|
| Rate for Payer: Ohio Health Group HMO |
$51,307.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,682.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,893.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,207.17
|
| Rate for Payer: PHCS Commercial |
$65,673.83
|
| Rate for Payer: United Healthcare All Payer |
$60,201.01
|
|
|
FEM DIS W/P MAK RS OSS 7CM L
|
Facility
|
OP
|
$70,194.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.27 |
| Max. Negotiated Rate |
$67,386.62 |
| Rate for Payer: Aetna Commercial |
$54,049.69
|
| Rate for Payer: Anthem Medicaid |
$24,139.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,751.63
|
| Rate for Payer: Cash Price |
$35,097.20
|
| Rate for Payer: Cigna Commercial |
$58,261.35
|
| Rate for Payer: First Health Commercial |
$66,684.68
|
| Rate for Payer: Humana Commercial |
$59,665.24
|
| Rate for Payer: Humana KY Medicaid |
$24,139.85
|
| Rate for Payer: Kentucky WC Medicaid |
$24,385.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,559.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,803.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,058.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,624.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,771.07
|
| Rate for Payer: Ohio Health Group HMO |
$52,645.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,038.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,125.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,760.26
|
| Rate for Payer: PHCS Commercial |
$67,386.62
|
| Rate for Payer: United Healthcare All Payer |
$61,771.07
|
|
|
FEM DIS W/P MAK RS OSS 7CM L
|
Facility
|
IP
|
$70,194.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.27 |
| Max. Negotiated Rate |
$67,386.62 |
| Rate for Payer: Aetna Commercial |
$54,049.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,751.63
|
| Rate for Payer: Cash Price |
$35,097.20
|
| Rate for Payer: Cigna Commercial |
$58,261.35
|
| Rate for Payer: First Health Commercial |
$66,684.68
|
| Rate for Payer: Humana Commercial |
$59,665.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,559.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,803.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,058.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,771.07
|
| Rate for Payer: Ohio Health Group HMO |
$52,645.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,038.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,125.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,760.26
|
| Rate for Payer: PHCS Commercial |
$67,386.62
|
| Rate for Payer: United Healthcare All Payer |
$61,771.07
|
|
