|
FEM POROUS GII P/S HA S5 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S5 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S6 LT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S6 LT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S6 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S6 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S7 LT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S7 LT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S7 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S7 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S8 LT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S8 LT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S8 RT
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POROUS GII P/S HA S8 RT
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
FEM POST WDG G2 5-6 5LG
|
Facility
|
IP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
|
FEM POST WDG G2 5-6 5LG
|
Facility
|
OP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem Medicaid |
$2,651.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Humana KY Medicaid |
$2,651.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,678.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
|
FEM POST WDG G2 7-8 5XS
|
Facility
|
IP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
|
FEM POST WDG G2 7-8 5XS
|
Facility
|
OP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem Medicaid |
$2,651.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Humana KY Medicaid |
$2,651.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,678.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
|
FEM PROX ELLIP OSS 7CM L
|
Facility
|
OP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem Medicaid |
$23,664.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Humana KY Medicaid |
$23,664.45
|
| Rate for Payer: Kentucky WC Medicaid |
$23,905.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,139.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
|
FEM PROX ELLIP OSS 7CM L
|
Facility
|
IP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
|
FEM PROX ELLIP OSS 7CM R
|
Facility
|
IP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
|
FEM PROX ELLIP OSS 7CM R
|
Facility
|
OP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem Medicaid |
$23,664.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Humana KY Medicaid |
$23,664.45
|
| Rate for Payer: Kentucky WC Medicaid |
$23,905.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,139.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
|
FEM PROX LOW-PROFILE OSS L
|
Facility
|
OP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem Medicaid |
$23,664.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Humana KY Medicaid |
$23,664.45
|
| Rate for Payer: Kentucky WC Medicaid |
$23,905.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,139.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
|
FEM PROX LOW-PROFILE OSS L
|
Facility
|
IP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
|
FEM PROX LOW-PROFILE OSS R
|
Facility
|
IP
|
$68,812.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,945.56 |
| Max. Negotiated Rate |
$66,059.52 |
| Rate for Payer: Aetna Commercial |
$52,985.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,673.36
|
| Rate for Payer: Cash Price |
$34,406.00
|
| Rate for Payer: Cigna Commercial |
$57,113.96
|
| Rate for Payer: First Health Commercial |
$65,371.40
|
| Rate for Payer: Humana Commercial |
$58,490.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,425.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,783.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,643.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,554.56
|
| Rate for Payer: Ohio Health Group HMO |
$51,609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,331.72
|
| Rate for Payer: PHCS Commercial |
$66,059.52
|
| Rate for Payer: United Healthcare All Payer |
$60,554.56
|
|
