|
FEM HD ZIRC 10/12 28MM +0 EXT
|
Facility
|
OP
|
$8,803.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.43 |
| Max. Negotiated Rate |
$8,451.21 |
| Rate for Payer: Aetna Commercial |
$6,778.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.61
|
| Rate for Payer: Cash Price |
$4,401.67
|
| Rate for Payer: Cigna Commercial |
$7,306.77
|
| Rate for Payer: First Health Commercial |
$8,363.17
|
| Rate for Payer: Humana Commercial |
$7,482.84
|
| Rate for Payer: Humana KY Medicaid |
$3,027.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,058.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,088.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.04
|
| Rate for Payer: PHCS Commercial |
$8,451.21
|
| Rate for Payer: United Healthcare All Payer |
$7,746.94
|
|
|
FEM HD ZIRC 10/12 28MM +0 EXT
|
Facility
|
IP
|
$8,803.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.43 |
| Max. Negotiated Rate |
$8,451.21 |
| Rate for Payer: Aetna Commercial |
$6,778.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.61
|
| Rate for Payer: Cash Price |
$4,401.67
|
| Rate for Payer: Cigna Commercial |
$7,306.77
|
| Rate for Payer: First Health Commercial |
$8,363.17
|
| Rate for Payer: Humana Commercial |
$7,482.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.04
|
| Rate for Payer: PHCS Commercial |
$8,451.21
|
| Rate for Payer: United Healthcare All Payer |
$7,746.94
|
|
|
FEM HD ZIRC 10/12 28MM +5 EXT
|
Facility
|
OP
|
$8,803.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.43 |
| Max. Negotiated Rate |
$8,451.21 |
| Rate for Payer: Aetna Commercial |
$6,778.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.61
|
| Rate for Payer: Cash Price |
$4,401.67
|
| Rate for Payer: Cigna Commercial |
$7,306.77
|
| Rate for Payer: First Health Commercial |
$8,363.17
|
| Rate for Payer: Humana Commercial |
$7,482.84
|
| Rate for Payer: Humana KY Medicaid |
$3,027.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,058.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,088.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.04
|
| Rate for Payer: PHCS Commercial |
$8,451.21
|
| Rate for Payer: United Healthcare All Payer |
$7,746.94
|
|
|
FEM HD ZIRC 10/12 28MM +5 EXT
|
Facility
|
IP
|
$8,803.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.43 |
| Max. Negotiated Rate |
$8,451.21 |
| Rate for Payer: Aetna Commercial |
$6,778.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.61
|
| Rate for Payer: Cash Price |
$4,401.67
|
| Rate for Payer: Cigna Commercial |
$7,306.77
|
| Rate for Payer: First Health Commercial |
$8,363.17
|
| Rate for Payer: Humana Commercial |
$7,482.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.04
|
| Rate for Payer: PHCS Commercial |
$8,451.21
|
| Rate for Payer: United Healthcare All Payer |
$7,746.94
|
|
|
FEM HD ZIRC 10/12 28MM -5 EXT
|
Facility
|
IP
|
$8,803.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.43 |
| Max. Negotiated Rate |
$8,451.21 |
| Rate for Payer: Aetna Commercial |
$6,778.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.61
|
| Rate for Payer: Cash Price |
$4,401.67
|
| Rate for Payer: Cigna Commercial |
$7,306.77
|
| Rate for Payer: First Health Commercial |
$8,363.17
|
| Rate for Payer: Humana Commercial |
$7,482.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.04
|
| Rate for Payer: PHCS Commercial |
$8,451.21
|
| Rate for Payer: United Healthcare All Payer |
$7,746.94
|
|
|
FEM HD ZIRC 10/12 28MM -5 EXT
|
Facility
|
OP
|
$8,803.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.43 |
| Max. Negotiated Rate |
$8,451.21 |
| Rate for Payer: Aetna Commercial |
$6,778.57
|
| Rate for Payer: Anthem Medicaid |
$3,027.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.61
|
| Rate for Payer: Cash Price |
$4,401.67
|
| Rate for Payer: Cigna Commercial |
$7,306.77
|
| Rate for Payer: First Health Commercial |
$8,363.17
|
| Rate for Payer: Humana Commercial |
$7,482.84
|
| Rate for Payer: Humana KY Medicaid |
$3,027.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,058.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,088.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,144.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,729.04
|
| Rate for Payer: PHCS Commercial |
$8,451.21
|
| Rate for Payer: United Healthcare All Payer |
$7,746.94
|
|
|
FEM HEAD TPR +16 12/14 36MM
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEAD TPR +16 12/14 36MM
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEAD TRAIL 12/14 32MM +16
|
Facility
|
IP
|
$1,939.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.08 |
| Max. Negotiated Rate |
$1,861.49 |
| Rate for Payer: Aetna Commercial |
$1,493.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,512.46
|
| Rate for Payer: Cash Price |
$969.52
|
| Rate for Payer: Cigna Commercial |
$1,609.41
|
| Rate for Payer: First Health Commercial |
$1,842.10
|
| Rate for Payer: Humana Commercial |
$1,648.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,706.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,454.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.11
|
| Rate for Payer: PHCS Commercial |
$1,861.49
|
| Rate for Payer: United Healthcare All Payer |
$1,706.36
|
|
|
FEM HEAD TRAIL 12/14 32MM +16
|
Facility
|
OP
|
$1,939.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.08 |
| Max. Negotiated Rate |
$1,861.49 |
| Rate for Payer: Aetna Commercial |
$1,493.07
|
| Rate for Payer: Anthem Medicaid |
$666.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,512.46
|
| Rate for Payer: Cash Price |
$969.52
|
| Rate for Payer: Cigna Commercial |
$1,609.41
|
| Rate for Payer: First Health Commercial |
$1,842.10
|
| Rate for Payer: Humana Commercial |
$1,648.19
|
| Rate for Payer: Humana KY Medicaid |
$666.84
|
| Rate for Payer: Kentucky WC Medicaid |
$673.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,706.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,454.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.11
|
| Rate for Payer: PHCS Commercial |
$1,861.49
|
| Rate for Payer: United Healthcare All Payer |
$1,706.36
|
|
|
FEM HEAD TRIAL V40 STANDARD
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.21 |
| Max. Negotiated Rate |
$1,840.32 |
| Rate for Payer: Aetna Commercial |
$1,476.09
|
| Rate for Payer: Anthem Medicaid |
$659.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.26
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cigna Commercial |
$1,591.11
|
| Rate for Payer: First Health Commercial |
$1,821.15
|
| Rate for Payer: Humana Commercial |
$1,629.45
|
| Rate for Payer: Humana KY Medicaid |
$659.26
|
| Rate for Payer: Kentucky WC Medicaid |
$665.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$672.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.27
|
| Rate for Payer: PHCS Commercial |
$1,840.32
|
| Rate for Payer: United Healthcare All Payer |
$1,686.96
|
|
|
FEM HEAD TRIAL V40 STANDARD
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.21 |
| Max. Negotiated Rate |
$1,840.32 |
| Rate for Payer: Aetna Commercial |
$1,476.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.26
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cigna Commercial |
$1,591.11
|
| Rate for Payer: First Health Commercial |
$1,821.15
|
| Rate for Payer: Humana Commercial |
$1,629.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.27
|
| Rate for Payer: PHCS Commercial |
$1,840.32
|
| Rate for Payer: United Healthcare All Payer |
$1,686.96
|
|
|
FEM HEADUNIV COCR14/16 26MM +0
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 26MM +0
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 26MM +4
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 26MM +4
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 26MM +8
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 26MM +8
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 28MM +0
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 28MM +0
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 28MM +4
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 28MM +4
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 28MM +8
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 28MM +8
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
FEM HEADUNIV COCR14/16 32MM +0
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
