|
FEM NARROW PS NP SZ 6 RT
|
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 NEXGEN PRECOAT LPS B-LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS B-LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS B-RT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS B-RT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS C-LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS C-LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS C-RT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS C-RT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS D-LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS D-LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS D-RT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS D-RT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS E-LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS E-LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS E-RT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS E-RT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS F-LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS F-LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS F-RT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS F-RT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS G-LT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS G-LT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS G-RT
|
Facility
|
OP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem Medicaid |
$3,228.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Humana KY Medicaid |
$3,228.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,261.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
|
FEM NEXGEN PRECOAT LPS G-RT
|
Facility
|
IP
|
$9,388.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.47 |
| Max. Negotiated Rate |
$9,012.72 |
| Rate for Payer: Aetna Commercial |
$7,228.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,322.84
|
| Rate for Payer: Cash Price |
$4,694.12
|
| Rate for Payer: Cigna Commercial |
$7,792.25
|
| Rate for Payer: First Health Commercial |
$8,918.84
|
| Rate for Payer: Humana Commercial |
$7,980.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,698.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,928.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,816.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,261.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,041.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,877.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,220.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,910.36
|
| Rate for Payer: PHCS Commercial |
$9,012.72
|
| Rate for Payer: United Healthcare All Payer |
$8,261.66
|
|
