|
FEM JUNI FB COCR OX SZ 4 RM LL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 4 RM LL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 5 LM RL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 5 LM RL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 5 RM LL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 5 RM LL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 6 LM RL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 6 LM RL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 6 RM LL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 6 RM LL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 7 LM RL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 7 LM RL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 7 RM LL
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB COCR OX SZ 7 RM LL
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
FEM JUNI FB OX SZ 6 RM LL
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI FB OX SZ 6 RM LL
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI FB OX SZ 7 RM LL
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI FB OX SZ 7 RM LL
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI OX FB SZ 1 RM LL
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI OX FB SZ 1 RM LL
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI OX FB SZ 2 RM LL
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI OX FB SZ 2 RM LL
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI OX FB SZ 5 RM LL
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM JUNI OX FB SZ 5 RM LL
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
FEM MAXIM ILOK ANA PRI 60 RT
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
