|
FEM DIS W/P MAK RS OSS 7E 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 7E 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
|
|
|
FEM DIS W/P MAK RS OSS 7E R
|
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
|
|
|
FEM DIS W/P MAK RS OSS 7E R
|
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 8.5E L
|
Facility
|
OP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem Medicaid |
$24,439.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Humana KY Medicaid |
$24,439.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24,688.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,930.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5E L
|
Facility
|
IP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5E R
|
Facility
|
OP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem Medicaid |
$24,439.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Humana KY Medicaid |
$24,439.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24,688.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,930.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5E R
|
Facility
|
IP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5 L
|
Facility
|
IP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5 L
|
Facility
|
OP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem Medicaid |
$24,439.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Humana KY Medicaid |
$24,439.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24,688.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,930.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5 R
|
Facility
|
OP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem Medicaid |
$24,439.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Humana KY Medicaid |
$24,439.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24,688.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,930.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM DIS W/P MAK RS OSS 8.5 R
|
Facility
|
IP
|
$71,067.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,238.72 |
| Max. Negotiated Rate |
$68,224.36 |
| Rate for Payer: Aetna Commercial |
$54,721.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,432.29
|
| Rate for Payer: Cash Price |
$35,533.52
|
| Rate for Payer: Cigna Commercial |
$58,985.64
|
| Rate for Payer: First Health Commercial |
$67,513.69
|
| Rate for Payer: Humana Commercial |
$60,406.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,274.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,447.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,320.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,539.00
|
| Rate for Payer: Ohio Health Group HMO |
$53,300.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,213.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,238.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,030.78
|
| Rate for Payer: PHCS Commercial |
$68,224.36
|
| Rate for Payer: United Healthcare All Payer |
$62,539.00
|
|
|
FEM ELLIP OSS RS 7CM SEG L
|
Facility
|
IP
|
$72,851.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,470.66 |
| Max. Negotiated Rate |
$69,937.15 |
| Rate for Payer: Aetna Commercial |
$56,095.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,823.94
|
| Rate for Payer: Cash Price |
$36,425.60
|
| Rate for Payer: Cigna Commercial |
$60,466.50
|
| Rate for Payer: First Health Commercial |
$69,208.64
|
| Rate for Payer: Humana Commercial |
$61,923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,737.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,764.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,855.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,109.06
|
| Rate for Payer: Ohio Health Group HMO |
$54,638.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,570.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,470.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,583.87
|
| Rate for Payer: PHCS Commercial |
$69,937.15
|
| Rate for Payer: United Healthcare All Payer |
$64,109.06
|
|
|
FEM ELLIP OSS RS 7CM SEG L
|
Facility
|
OP
|
$72,851.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,470.66 |
| Max. Negotiated Rate |
$69,937.15 |
| Rate for Payer: Aetna Commercial |
$56,095.42
|
| Rate for Payer: Anthem Medicaid |
$25,053.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,823.94
|
| Rate for Payer: Cash Price |
$36,425.60
|
| Rate for Payer: Cigna Commercial |
$60,466.50
|
| Rate for Payer: First Health Commercial |
$69,208.64
|
| Rate for Payer: Humana Commercial |
$61,923.52
|
| Rate for Payer: Humana KY Medicaid |
$25,053.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,308.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,737.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,764.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,855.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,556.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,109.06
|
| Rate for Payer: Ohio Health Group HMO |
$54,638.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,570.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,470.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,583.87
|
| Rate for Payer: PHCS Commercial |
$69,937.15
|
| Rate for Payer: United Healthcare All Payer |
$64,109.06
|
|
|
FEM ELLIP OSS RS 7CM SEG R
|
Facility
|
IP
|
$72,851.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,470.66 |
| Max. Negotiated Rate |
$69,937.15 |
| Rate for Payer: Aetna Commercial |
$56,095.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,823.94
|
| Rate for Payer: Cash Price |
$36,425.60
|
| Rate for Payer: Cigna Commercial |
$60,466.50
|
| Rate for Payer: First Health Commercial |
$69,208.64
|
| Rate for Payer: Humana Commercial |
$61,923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,737.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,764.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,855.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,109.06
|
| Rate for Payer: Ohio Health Group HMO |
$54,638.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,570.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,470.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,583.87
|
| Rate for Payer: PHCS Commercial |
$69,937.15
|
| Rate for Payer: United Healthcare All Payer |
$64,109.06
|
|
|
FEM ELLIP OSS RS 7CM SEG R
|
Facility
|
OP
|
$72,851.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,470.66 |
| Max. Negotiated Rate |
$69,937.15 |
| Rate for Payer: Aetna Commercial |
$56,095.42
|
| Rate for Payer: Anthem Medicaid |
$25,053.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,823.94
|
| Rate for Payer: Cash Price |
$36,425.60
|
| Rate for Payer: Cigna Commercial |
$60,466.50
|
| Rate for Payer: First Health Commercial |
$69,208.64
|
| Rate for Payer: Humana Commercial |
$61,923.52
|
| Rate for Payer: Humana KY Medicaid |
$25,053.53
|
| Rate for Payer: Kentucky WC Medicaid |
$25,308.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,737.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,764.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,855.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,556.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,109.06
|
| Rate for Payer: Ohio Health Group HMO |
$54,638.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,570.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,470.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,583.87
|
| Rate for Payer: PHCS Commercial |
$69,937.15
|
| Rate for Payer: United Healthcare All Payer |
$64,109.06
|
|
|
FEM ELLIP OSS RS 8.5CM SEG L
|
Facility
|
IP
|
$75,508.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,816.04 |
| Max. Negotiated Rate |
$72,487.68 |
| Rate for Payer: Aetna Commercial |
$58,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,896.24
|
| Rate for Payer: Cash Price |
$37,754.00
|
| Rate for Payer: Cigna Commercial |
$62,671.64
|
| Rate for Payer: First Health Commercial |
$71,732.60
|
| Rate for Payer: Humana Commercial |
$64,181.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,916.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,724.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,652.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,447.04
|
| Rate for Payer: Ohio Health Group HMO |
$56,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,816.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,407.48
|
| Rate for Payer: PHCS Commercial |
$72,487.68
|
| Rate for Payer: United Healthcare All Payer |
$66,447.04
|
|
|
FEM ELLIP OSS RS 8.5CM SEG L
|
Facility
|
OP
|
$75,508.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,816.04 |
| Max. Negotiated Rate |
$72,487.68 |
| Rate for Payer: Aetna Commercial |
$58,141.16
|
| Rate for Payer: Anthem Medicaid |
$25,967.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,896.24
|
| Rate for Payer: Cash Price |
$37,754.00
|
| Rate for Payer: Cigna Commercial |
$62,671.64
|
| Rate for Payer: First Health Commercial |
$71,732.60
|
| Rate for Payer: Humana Commercial |
$64,181.80
|
| Rate for Payer: Humana KY Medicaid |
$25,967.20
|
| Rate for Payer: Kentucky WC Medicaid |
$26,231.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,916.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,724.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,652.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,488.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,447.04
|
| Rate for Payer: Ohio Health Group HMO |
$56,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,816.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,407.48
|
| Rate for Payer: PHCS Commercial |
$72,487.68
|
| Rate for Payer: United Healthcare All Payer |
$66,447.04
|
|
|
FEM ELLIP OSS RS 8.5CM SEG R
|
Facility
|
IP
|
$75,508.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,816.04 |
| Max. Negotiated Rate |
$72,487.68 |
| Rate for Payer: Aetna Commercial |
$58,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,896.24
|
| Rate for Payer: Cash Price |
$37,754.00
|
| Rate for Payer: Cigna Commercial |
$62,671.64
|
| Rate for Payer: First Health Commercial |
$71,732.60
|
| Rate for Payer: Humana Commercial |
$64,181.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,916.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,724.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,652.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,447.04
|
| Rate for Payer: Ohio Health Group HMO |
$56,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,816.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,407.48
|
| Rate for Payer: PHCS Commercial |
$72,487.68
|
| Rate for Payer: United Healthcare All Payer |
$66,447.04
|
|
|
FEM ELLIP OSS RS 8.5CM SEG R
|
Facility
|
OP
|
$75,508.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,816.04 |
| Max. Negotiated Rate |
$72,487.68 |
| Rate for Payer: Aetna Commercial |
$58,141.16
|
| Rate for Payer: Anthem Medicaid |
$25,967.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,896.24
|
| Rate for Payer: Cash Price |
$37,754.00
|
| Rate for Payer: Cigna Commercial |
$62,671.64
|
| Rate for Payer: First Health Commercial |
$71,732.60
|
| Rate for Payer: Humana Commercial |
$64,181.80
|
| Rate for Payer: Humana KY Medicaid |
$25,967.20
|
| Rate for Payer: Kentucky WC Medicaid |
$26,231.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,916.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,724.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,652.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,488.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,447.04
|
| Rate for Payer: Ohio Health Group HMO |
$56,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,816.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,407.48
|
| Rate for Payer: PHCS Commercial |
$72,487.68
|
| Rate for Payer: United Healthcare All Payer |
$66,447.04
|
|
|
FEM EX SM STR 22MM HD 105
|
Facility
|
IP
|
$15,136.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,967.74 |
| Max. Negotiated Rate |
$14,530.98 |
| Rate for Payer: Aetna Commercial |
$11,655.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,806.42
|
| Rate for Payer: Cash Price |
$7,568.22
|
| Rate for Payer: Cigna Commercial |
$12,563.25
|
| Rate for Payer: First Health Commercial |
$14,379.62
|
| Rate for Payer: Humana Commercial |
$12,865.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,170.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,320.07
|
| Rate for Payer: Ohio Health Group HMO |
$11,352.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,027.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,967.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,692.30
|
| Rate for Payer: PHCS Commercial |
$14,530.98
|
| Rate for Payer: United Healthcare All Payer |
$13,320.07
|
|
|
FEM EX SM STR 22MM HD 105
|
Facility
|
OP
|
$15,136.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,967.74 |
| Max. Negotiated Rate |
$14,530.98 |
| Rate for Payer: Aetna Commercial |
$11,655.06
|
| Rate for Payer: Anthem Medicaid |
$5,205.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,806.42
|
| Rate for Payer: Cash Price |
$7,568.22
|
| Rate for Payer: Cigna Commercial |
$12,563.25
|
| Rate for Payer: First Health Commercial |
$14,379.62
|
| Rate for Payer: Humana Commercial |
$12,865.97
|
| Rate for Payer: Humana KY Medicaid |
$5,205.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,411.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,170.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,540.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,309.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,320.07
|
| Rate for Payer: Ohio Health Group HMO |
$11,352.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,027.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,967.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,692.30
|
| Rate for Payer: PHCS Commercial |
$14,530.98
|
| Rate for Payer: United Healthcare All Payer |
$13,320.07
|
|
|
FEM GNS C/R II SZ1 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 GNS C/R II SZ1 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 GNS C/R II SZ2 LT
|
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
|
|
