|
FEM BLUSHINGS POLY RS OSS
|
Facility
|
IP
|
$4,313.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.01 |
| Max. Negotiated Rate |
$4,140.84 |
| Rate for Payer: Aetna Commercial |
$3,321.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.44
|
| Rate for Payer: Cash Price |
$2,156.69
|
| Rate for Payer: Cigna Commercial |
$3,580.11
|
| Rate for Payer: First Health Commercial |
$4,097.71
|
| Rate for Payer: Humana Commercial |
$3,666.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,536.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,795.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,450.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,752.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,976.23
|
| Rate for Payer: PHCS Commercial |
$4,140.84
|
| Rate for Payer: United Healthcare All Payer |
$3,795.77
|
|
|
FEM COMP OSS RS 3CM RESUR L
|
Facility
|
IP
|
$71,529.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,458.86 |
| Max. Negotiated Rate |
$68,668.34 |
| Rate for Payer: Aetna Commercial |
$55,077.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,793.03
|
| Rate for Payer: Cash Price |
$35,764.76
|
| Rate for Payer: Cigna Commercial |
$59,369.50
|
| Rate for Payer: First Health Commercial |
$67,953.04
|
| Rate for Payer: Humana Commercial |
$60,800.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,654.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,788.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,458.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,945.98
|
| Rate for Payer: Ohio Health Group HMO |
$53,647.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,223.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,230.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,355.37
|
| Rate for Payer: PHCS Commercial |
$68,668.34
|
| Rate for Payer: United Healthcare All Payer |
$62,945.98
|
|
|
FEM COMP OSS RS 3CM RESUR L
|
Facility
|
OP
|
$71,529.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,458.86 |
| Max. Negotiated Rate |
$68,668.34 |
| Rate for Payer: Aetna Commercial |
$55,077.73
|
| Rate for Payer: Anthem Medicaid |
$24,599.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,793.03
|
| Rate for Payer: Cash Price |
$35,764.76
|
| Rate for Payer: Cigna Commercial |
$59,369.50
|
| Rate for Payer: First Health Commercial |
$67,953.04
|
| Rate for Payer: Humana Commercial |
$60,800.09
|
| Rate for Payer: Humana KY Medicaid |
$24,599.00
|
| Rate for Payer: Kentucky WC Medicaid |
$24,849.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,654.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,788.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,458.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,092.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,945.98
|
| Rate for Payer: Ohio Health Group HMO |
$53,647.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,223.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,230.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,355.37
|
| Rate for Payer: PHCS Commercial |
$68,668.34
|
| Rate for Payer: United Healthcare All Payer |
$62,945.98
|
|
|
FEM COMP OSS RS 3CM RESUR R
|
Facility
|
IP
|
$71,529.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,458.86 |
| Max. Negotiated Rate |
$68,668.34 |
| Rate for Payer: Aetna Commercial |
$55,077.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,793.03
|
| Rate for Payer: Cash Price |
$35,764.76
|
| Rate for Payer: Cigna Commercial |
$59,369.50
|
| Rate for Payer: First Health Commercial |
$67,953.04
|
| Rate for Payer: Humana Commercial |
$60,800.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,654.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,788.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,458.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,945.98
|
| Rate for Payer: Ohio Health Group HMO |
$53,647.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,223.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,230.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,355.37
|
| Rate for Payer: PHCS Commercial |
$68,668.34
|
| Rate for Payer: United Healthcare All Payer |
$62,945.98
|
|
|
FEM COMP OSS RS 3CM RESUR R
|
Facility
|
OP
|
$71,529.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,458.86 |
| Max. Negotiated Rate |
$68,668.34 |
| Rate for Payer: Aetna Commercial |
$55,077.73
|
| Rate for Payer: Anthem Medicaid |
$24,599.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,793.03
|
| Rate for Payer: Cash Price |
$35,764.76
|
| Rate for Payer: Cigna Commercial |
$59,369.50
|
| Rate for Payer: First Health Commercial |
$67,953.04
|
| Rate for Payer: Humana Commercial |
$60,800.09
|
| Rate for Payer: Humana KY Medicaid |
$24,599.00
|
| Rate for Payer: Kentucky WC Medicaid |
$24,849.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,654.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,788.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,458.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,092.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,945.98
|
| Rate for Payer: Ohio Health Group HMO |
$53,647.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,223.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,230.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,355.37
|
| Rate for Payer: PHCS Commercial |
$68,668.34
|
| Rate for Payer: United Healthcare All Payer |
$62,945.98
|
|
|
FEM COMP OSS RS 5CM RESUR L
|
Facility
|
OP
|
$72,455.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,736.56 |
| Max. Negotiated Rate |
$69,556.99 |
| Rate for Payer: Aetna Commercial |
$55,790.50
|
| Rate for Payer: Anthem Medicaid |
$24,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,515.06
|
| Rate for Payer: Cash Price |
$36,227.60
|
| Rate for Payer: Cigna Commercial |
$60,137.82
|
| Rate for Payer: First Health Commercial |
$68,832.44
|
| Rate for Payer: Humana Commercial |
$61,586.92
|
| Rate for Payer: Humana KY Medicaid |
$24,917.34
|
| Rate for Payer: Kentucky WC Medicaid |
$25,170.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,471.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,736.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,417.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,760.58
|
| Rate for Payer: Ohio Health Group HMO |
$54,341.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,964.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,036.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,994.09
|
| Rate for Payer: PHCS Commercial |
$69,556.99
|
| Rate for Payer: United Healthcare All Payer |
$63,760.58
|
|
|
FEM COMP OSS RS 5CM RESUR L
|
Facility
|
IP
|
$72,455.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,736.56 |
| Max. Negotiated Rate |
$69,556.99 |
| Rate for Payer: Aetna Commercial |
$55,790.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,515.06
|
| Rate for Payer: Cash Price |
$36,227.60
|
| Rate for Payer: Cigna Commercial |
$60,137.82
|
| Rate for Payer: First Health Commercial |
$68,832.44
|
| Rate for Payer: Humana Commercial |
$61,586.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,471.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,736.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,760.58
|
| Rate for Payer: Ohio Health Group HMO |
$54,341.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,964.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,036.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,994.09
|
| Rate for Payer: PHCS Commercial |
$69,556.99
|
| Rate for Payer: United Healthcare All Payer |
$63,760.58
|
|
|
FEM COMP OSS RS 5CM RESUR R
|
Facility
|
IP
|
$72,455.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,736.56 |
| Max. Negotiated Rate |
$69,556.99 |
| Rate for Payer: Aetna Commercial |
$55,790.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,515.06
|
| Rate for Payer: Cash Price |
$36,227.60
|
| Rate for Payer: Cigna Commercial |
$60,137.82
|
| Rate for Payer: First Health Commercial |
$68,832.44
|
| Rate for Payer: Humana Commercial |
$61,586.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,471.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,736.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,760.58
|
| Rate for Payer: Ohio Health Group HMO |
$54,341.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,964.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,036.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,994.09
|
| Rate for Payer: PHCS Commercial |
$69,556.99
|
| Rate for Payer: United Healthcare All Payer |
$63,760.58
|
|
|
FEM COMP OSS RS 5CM RESUR R
|
Facility
|
OP
|
$72,455.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,736.56 |
| Max. Negotiated Rate |
$69,556.99 |
| Rate for Payer: Aetna Commercial |
$55,790.50
|
| Rate for Payer: Anthem Medicaid |
$24,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,515.06
|
| Rate for Payer: Cash Price |
$36,227.60
|
| Rate for Payer: Cigna Commercial |
$60,137.82
|
| Rate for Payer: First Health Commercial |
$68,832.44
|
| Rate for Payer: Humana Commercial |
$61,586.92
|
| Rate for Payer: Humana KY Medicaid |
$24,917.34
|
| Rate for Payer: Kentucky WC Medicaid |
$25,170.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,413.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,471.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,736.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,417.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,760.58
|
| Rate for Payer: Ohio Health Group HMO |
$54,341.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,964.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,036.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,994.09
|
| Rate for Payer: PHCS Commercial |
$69,556.99
|
| Rate for Payer: United Healthcare All Payer |
$63,760.58
|
|
|
FEM COMP TOTAL STABILIZR #11RT
|
Facility
|
OP
|
$24,137.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,241.10 |
| Max. Negotiated Rate |
$23,171.52 |
| Rate for Payer: Aetna Commercial |
$18,585.49
|
| Rate for Payer: Anthem Medicaid |
$8,300.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,826.86
|
| Rate for Payer: Cash Price |
$12,068.50
|
| Rate for Payer: Cigna Commercial |
$20,033.71
|
| Rate for Payer: First Health Commercial |
$22,930.15
|
| Rate for Payer: Humana Commercial |
$20,516.45
|
| Rate for Payer: Humana KY Medicaid |
$8,300.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,385.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,792.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,813.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,241.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,467.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,240.56
|
| Rate for Payer: Ohio Health Group HMO |
$18,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,999.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,654.53
|
| Rate for Payer: PHCS Commercial |
$23,171.52
|
| Rate for Payer: United Healthcare All Payer |
$21,240.56
|
|
|
FEM COMP TOTAL STABILIZR #11RT
|
Facility
|
IP
|
$24,137.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,241.10 |
| Max. Negotiated Rate |
$23,171.52 |
| Rate for Payer: Aetna Commercial |
$18,585.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,826.86
|
| Rate for Payer: Cash Price |
$12,068.50
|
| Rate for Payer: Cigna Commercial |
$20,033.71
|
| Rate for Payer: First Health Commercial |
$22,930.15
|
| Rate for Payer: Humana Commercial |
$20,516.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,792.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,813.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,241.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,240.56
|
| Rate for Payer: Ohio Health Group HMO |
$18,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,999.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,654.53
|
| Rate for Payer: PHCS Commercial |
$23,171.52
|
| Rate for Payer: United Healthcare All Payer |
$21,240.56
|
|
|
FEM COMP TOTAL STABILIZR #13LT
|
Facility
|
OP
|
$20,369.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.70 |
| Max. Negotiated Rate |
$19,554.24 |
| Rate for Payer: Aetna Commercial |
$15,684.13
|
| Rate for Payer: Anthem Medicaid |
$7,004.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,887.82
|
| Rate for Payer: Cash Price |
$10,184.50
|
| Rate for Payer: Cigna Commercial |
$16,906.27
|
| Rate for Payer: First Health Commercial |
$19,350.55
|
| Rate for Payer: Humana Commercial |
$17,313.65
|
| Rate for Payer: Humana KY Medicaid |
$7,004.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,076.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,702.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,032.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,145.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,924.72
|
| Rate for Payer: Ohio Health Group HMO |
$15,276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,721.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,054.61
|
| Rate for Payer: PHCS Commercial |
$19,554.24
|
| Rate for Payer: United Healthcare All Payer |
$17,924.72
|
|
|
FEM COMP TOTAL STABILIZR #13LT
|
Facility
|
IP
|
$20,369.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.70 |
| Max. Negotiated Rate |
$19,554.24 |
| Rate for Payer: Aetna Commercial |
$15,684.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,887.82
|
| Rate for Payer: Cash Price |
$10,184.50
|
| Rate for Payer: Cigna Commercial |
$16,906.27
|
| Rate for Payer: First Health Commercial |
$19,350.55
|
| Rate for Payer: Humana Commercial |
$17,313.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,702.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,032.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,924.72
|
| Rate for Payer: Ohio Health Group HMO |
$15,276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,721.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,054.61
|
| Rate for Payer: PHCS Commercial |
$19,554.24
|
| Rate for Payer: United Healthcare All Payer |
$17,924.72
|
|
|
FEM COMP TOTAL STABILIZR #13RT
|
Facility
|
OP
|
$20,369.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.70 |
| Max. Negotiated Rate |
$19,554.24 |
| Rate for Payer: Aetna Commercial |
$15,684.13
|
| Rate for Payer: Anthem Medicaid |
$7,004.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,887.82
|
| Rate for Payer: Cash Price |
$10,184.50
|
| Rate for Payer: Cigna Commercial |
$16,906.27
|
| Rate for Payer: First Health Commercial |
$19,350.55
|
| Rate for Payer: Humana Commercial |
$17,313.65
|
| Rate for Payer: Humana KY Medicaid |
$7,004.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,076.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,702.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,032.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,145.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,924.72
|
| Rate for Payer: Ohio Health Group HMO |
$15,276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,721.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,054.61
|
| Rate for Payer: PHCS Commercial |
$19,554.24
|
| Rate for Payer: United Healthcare All Payer |
$17,924.72
|
|
|
FEM COMP TOTAL STABILIZR #13RT
|
Facility
|
IP
|
$20,369.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.70 |
| Max. Negotiated Rate |
$19,554.24 |
| Rate for Payer: Aetna Commercial |
$15,684.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,887.82
|
| Rate for Payer: Cash Price |
$10,184.50
|
| Rate for Payer: Cigna Commercial |
$16,906.27
|
| Rate for Payer: First Health Commercial |
$19,350.55
|
| Rate for Payer: Humana Commercial |
$17,313.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,702.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,032.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,924.72
|
| Rate for Payer: Ohio Health Group HMO |
$15,276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,721.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,054.61
|
| Rate for Payer: PHCS Commercial |
$19,554.24
|
| Rate for Payer: United Healthcare All Payer |
$17,924.72
|
|
|
FEM COMP TOTAL STABILIZR #3/LT
|
Facility
|
OP
|
$20,369.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.70 |
| Max. Negotiated Rate |
$19,554.24 |
| Rate for Payer: Aetna Commercial |
$15,684.13
|
| Rate for Payer: Anthem Medicaid |
$7,004.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,887.82
|
| Rate for Payer: Cash Price |
$10,184.50
|
| Rate for Payer: Cigna Commercial |
$16,906.27
|
| Rate for Payer: First Health Commercial |
$19,350.55
|
| Rate for Payer: Humana Commercial |
$17,313.65
|
| Rate for Payer: Humana KY Medicaid |
$7,004.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,076.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,702.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,032.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,145.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,924.72
|
| Rate for Payer: Ohio Health Group HMO |
$15,276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,721.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,054.61
|
| Rate for Payer: PHCS Commercial |
$19,554.24
|
| Rate for Payer: United Healthcare All Payer |
$17,924.72
|
|
|
FEM COMP TOTAL STABILIZR #3/LT
|
Facility
|
IP
|
$20,369.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.70 |
| Max. Negotiated Rate |
$19,554.24 |
| Rate for Payer: Aetna Commercial |
$15,684.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,887.82
|
| Rate for Payer: Cash Price |
$10,184.50
|
| Rate for Payer: Cigna Commercial |
$16,906.27
|
| Rate for Payer: First Health Commercial |
$19,350.55
|
| Rate for Payer: Humana Commercial |
$17,313.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,702.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,032.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,924.72
|
| Rate for Payer: Ohio Health Group HMO |
$15,276.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,721.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,054.61
|
| Rate for Payer: PHCS Commercial |
$19,554.24
|
| Rate for Payer: United Healthcare All Payer |
$17,924.72
|
|
|
FEM COMP TOTAL STABILIZR #3/RT
|
Facility
|
IP
|
$20,367.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.25 |
| Max. Negotiated Rate |
$19,552.80 |
| Rate for Payer: Aetna Commercial |
$15,682.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,886.65
|
| Rate for Payer: Cash Price |
$10,183.75
|
| Rate for Payer: Cigna Commercial |
$16,905.03
|
| Rate for Payer: First Health Commercial |
$19,349.12
|
| Rate for Payer: Humana Commercial |
$17,312.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,701.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,031.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,923.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,275.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,719.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,053.58
|
| Rate for Payer: PHCS Commercial |
$19,552.80
|
| Rate for Payer: United Healthcare All Payer |
$17,923.40
|
|
|
FEM COMP TOTAL STABILIZR #3/RT
|
Facility
|
OP
|
$20,367.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,110.25 |
| Max. Negotiated Rate |
$19,552.80 |
| Rate for Payer: Aetna Commercial |
$15,682.98
|
| Rate for Payer: Anthem Medicaid |
$7,004.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,886.65
|
| Rate for Payer: Cash Price |
$10,183.75
|
| Rate for Payer: Cigna Commercial |
$16,905.03
|
| Rate for Payer: First Health Commercial |
$19,349.12
|
| Rate for Payer: Humana Commercial |
$17,312.38
|
| Rate for Payer: Humana KY Medicaid |
$7,004.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,075.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,701.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,031.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,110.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,144.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,923.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,275.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,294.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,719.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,053.58
|
| Rate for Payer: PHCS Commercial |
$19,552.80
|
| Rate for Payer: United Healthcare All Payer |
$17,923.40
|
|
|
FEM COMP TOTAL STABILIZR #5 LT
|
Facility
|
IP
|
$24,137.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,241.10 |
| Max. Negotiated Rate |
$23,171.52 |
| Rate for Payer: Aetna Commercial |
$18,585.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,826.86
|
| Rate for Payer: Cash Price |
$12,068.50
|
| Rate for Payer: Cigna Commercial |
$20,033.71
|
| Rate for Payer: First Health Commercial |
$22,930.15
|
| Rate for Payer: Humana Commercial |
$20,516.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,792.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,813.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,241.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,240.56
|
| Rate for Payer: Ohio Health Group HMO |
$18,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,999.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,654.53
|
| Rate for Payer: PHCS Commercial |
$23,171.52
|
| Rate for Payer: United Healthcare All Payer |
$21,240.56
|
|
|
FEM COMP TOTAL STABILIZR #5 LT
|
Facility
|
OP
|
$24,137.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,241.10 |
| Max. Negotiated Rate |
$23,171.52 |
| Rate for Payer: Aetna Commercial |
$18,585.49
|
| Rate for Payer: Anthem Medicaid |
$8,300.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,826.86
|
| Rate for Payer: Cash Price |
$12,068.50
|
| Rate for Payer: Cigna Commercial |
$20,033.71
|
| Rate for Payer: First Health Commercial |
$22,930.15
|
| Rate for Payer: Humana Commercial |
$20,516.45
|
| Rate for Payer: Humana KY Medicaid |
$8,300.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,385.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,792.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,813.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,241.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,467.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,240.56
|
| Rate for Payer: Ohio Health Group HMO |
$18,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,999.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,654.53
|
| Rate for Payer: PHCS Commercial |
$23,171.52
|
| Rate for Payer: United Healthcare All Payer |
$21,240.56
|
|
|
FEM COMP TOTAL STABILIZR #5/RT
|
Facility
|
IP
|
$24,137.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,241.10 |
| Max. Negotiated Rate |
$23,171.52 |
| Rate for Payer: Aetna Commercial |
$18,585.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,826.86
|
| Rate for Payer: Cash Price |
$12,068.50
|
| Rate for Payer: Cigna Commercial |
$20,033.71
|
| Rate for Payer: First Health Commercial |
$22,930.15
|
| Rate for Payer: Humana Commercial |
$20,516.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,792.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,813.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,241.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,240.56
|
| Rate for Payer: Ohio Health Group HMO |
$18,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,999.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,654.53
|
| Rate for Payer: PHCS Commercial |
$23,171.52
|
| Rate for Payer: United Healthcare All Payer |
$21,240.56
|
|
|
FEM COMP TOTAL STABILIZR #5/RT
|
Facility
|
OP
|
$24,137.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,241.10 |
| Max. Negotiated Rate |
$23,171.52 |
| Rate for Payer: Aetna Commercial |
$18,585.49
|
| Rate for Payer: Anthem Medicaid |
$8,300.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,826.86
|
| Rate for Payer: Cash Price |
$12,068.50
|
| Rate for Payer: Cigna Commercial |
$20,033.71
|
| Rate for Payer: First Health Commercial |
$22,930.15
|
| Rate for Payer: Humana Commercial |
$20,516.45
|
| Rate for Payer: Humana KY Medicaid |
$8,300.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,385.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,792.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,813.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,241.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,467.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,240.56
|
| Rate for Payer: Ohio Health Group HMO |
$18,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,999.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,654.53
|
| Rate for Payer: PHCS Commercial |
$23,171.52
|
| Rate for Payer: United Healthcare All Payer |
$21,240.56
|
|
|
FEM COMP TOTAL STABILIZR #7 LT
|
Facility
|
IP
|
$25,286.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,585.80 |
| Max. Negotiated Rate |
$24,274.56 |
| Rate for Payer: Aetna Commercial |
$19,470.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,723.08
|
| Rate for Payer: Cash Price |
$12,643.00
|
| Rate for Payer: Cigna Commercial |
$20,987.38
|
| Rate for Payer: First Health Commercial |
$24,021.70
|
| Rate for Payer: Humana Commercial |
$21,493.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,734.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,661.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,585.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,251.68
|
| Rate for Payer: Ohio Health Group HMO |
$18,964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,998.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,447.34
|
| Rate for Payer: PHCS Commercial |
$24,274.56
|
| Rate for Payer: United Healthcare All Payer |
$22,251.68
|
|
|
FEM COMP TOTAL STABILIZR #7 LT
|
Facility
|
OP
|
$25,286.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,585.80 |
| Max. Negotiated Rate |
$24,274.56 |
| Rate for Payer: Aetna Commercial |
$19,470.22
|
| Rate for Payer: Anthem Medicaid |
$8,695.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,723.08
|
| Rate for Payer: Cash Price |
$12,643.00
|
| Rate for Payer: Cigna Commercial |
$20,987.38
|
| Rate for Payer: First Health Commercial |
$24,021.70
|
| Rate for Payer: Humana Commercial |
$21,493.10
|
| Rate for Payer: Humana KY Medicaid |
$8,695.86
|
| Rate for Payer: Kentucky WC Medicaid |
$8,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,734.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,661.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,585.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,870.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,251.68
|
| Rate for Payer: Ohio Health Group HMO |
$18,964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,998.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,447.34
|
| Rate for Payer: PHCS Commercial |
$24,274.56
|
| Rate for Payer: United Healthcare All Payer |
$22,251.68
|
|
