|
FEM COMP TOTAL STABILIZR #7 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 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 #9 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 #9 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 STABLIZR #11 LT
|
Facility
|
IP
|
$23,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,916.20 |
| Max. Negotiated Rate |
$22,131.84 |
| Rate for Payer: Aetna Commercial |
$17,751.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,982.12
|
| Rate for Payer: Cash Price |
$11,527.00
|
| Rate for Payer: Cigna Commercial |
$19,134.82
|
| Rate for Payer: First Health Commercial |
$21,901.30
|
| Rate for Payer: Humana Commercial |
$19,595.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,904.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,013.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,916.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,287.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,290.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,056.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,907.26
|
| Rate for Payer: PHCS Commercial |
$22,131.84
|
| Rate for Payer: United Healthcare All Payer |
$20,287.52
|
|
|
FEM COMP TOTAL STABLIZR #11 LT
|
Facility
|
OP
|
$23,054.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,916.20 |
| Max. Negotiated Rate |
$22,131.84 |
| Rate for Payer: Aetna Commercial |
$17,751.58
|
| Rate for Payer: Anthem Medicaid |
$7,928.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,982.12
|
| Rate for Payer: Cash Price |
$11,527.00
|
| Rate for Payer: Cigna Commercial |
$19,134.82
|
| Rate for Payer: First Health Commercial |
$21,901.30
|
| Rate for Payer: Humana Commercial |
$19,595.90
|
| Rate for Payer: Humana KY Medicaid |
$7,928.27
|
| Rate for Payer: Kentucky WC Medicaid |
$8,008.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,904.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,013.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,916.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,087.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,287.52
|
| Rate for Payer: Ohio Health Group HMO |
$17,290.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,056.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,907.26
|
| Rate for Payer: PHCS Commercial |
$22,131.84
|
| Rate for Payer: United Healthcare All Payer |
$20,287.52
|
|
|
FEM CPS SEG OSS TPR 8.5CM L
|
Facility
|
IP
|
$75,054.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,516.32 |
| Max. Negotiated Rate |
$72,052.22 |
| Rate for Payer: Aetna Commercial |
$57,791.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,542.43
|
| Rate for Payer: Cash Price |
$37,527.20
|
| Rate for Payer: Cigna Commercial |
$62,295.15
|
| Rate for Payer: First Health Commercial |
$71,301.68
|
| Rate for Payer: Humana Commercial |
$63,796.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,544.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,390.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,516.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,047.87
|
| Rate for Payer: Ohio Health Group HMO |
$56,290.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,043.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,297.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,787.54
|
| Rate for Payer: PHCS Commercial |
$72,052.22
|
| Rate for Payer: United Healthcare All Payer |
$66,047.87
|
|
|
FEM CPS SEG OSS TPR 8.5CM L
|
Facility
|
OP
|
$75,054.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,516.32 |
| Max. Negotiated Rate |
$72,052.22 |
| Rate for Payer: Aetna Commercial |
$57,791.89
|
| Rate for Payer: Anthem Medicaid |
$25,811.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,542.43
|
| Rate for Payer: Cash Price |
$37,527.20
|
| Rate for Payer: Cigna Commercial |
$62,295.15
|
| Rate for Payer: First Health Commercial |
$71,301.68
|
| Rate for Payer: Humana Commercial |
$63,796.24
|
| Rate for Payer: Humana KY Medicaid |
$25,811.21
|
| Rate for Payer: Kentucky WC Medicaid |
$26,073.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,544.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,390.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,516.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,329.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,047.87
|
| Rate for Payer: Ohio Health Group HMO |
$56,290.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,043.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,297.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,787.54
|
| Rate for Payer: PHCS Commercial |
$72,052.22
|
| Rate for Payer: United Healthcare All Payer |
$66,047.87
|
|
|
FEM CPS SEG OSS TPR 8.5CM R
|
Facility
|
OP
|
$75,054.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,516.32 |
| Max. Negotiated Rate |
$72,052.22 |
| Rate for Payer: Aetna Commercial |
$57,791.89
|
| Rate for Payer: Anthem Medicaid |
$25,811.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,542.43
|
| Rate for Payer: Cash Price |
$37,527.20
|
| Rate for Payer: Cigna Commercial |
$62,295.15
|
| Rate for Payer: First Health Commercial |
$71,301.68
|
| Rate for Payer: Humana Commercial |
$63,796.24
|
| Rate for Payer: Humana KY Medicaid |
$25,811.21
|
| Rate for Payer: Kentucky WC Medicaid |
$26,073.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,544.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,390.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,516.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,329.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,047.87
|
| Rate for Payer: Ohio Health Group HMO |
$56,290.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,043.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,297.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,787.54
|
| Rate for Payer: PHCS Commercial |
$72,052.22
|
| Rate for Payer: United Healthcare All Payer |
$66,047.87
|
|
|
FEM CPS SEG OSS TPR 8.5CM R
|
Facility
|
IP
|
$75,054.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,516.32 |
| Max. Negotiated Rate |
$72,052.22 |
| Rate for Payer: Aetna Commercial |
$57,791.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,542.43
|
| Rate for Payer: Cash Price |
$37,527.20
|
| Rate for Payer: Cigna Commercial |
$62,295.15
|
| Rate for Payer: First Health Commercial |
$71,301.68
|
| Rate for Payer: Humana Commercial |
$63,796.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,544.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,390.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,516.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,047.87
|
| Rate for Payer: Ohio Health Group HMO |
$56,290.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,043.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,297.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,787.54
|
| Rate for Payer: PHCS Commercial |
$72,052.22
|
| Rate for Payer: United Healthcare All Payer |
$66,047.87
|
|
|
FEM C/R GNS II SZ4 RT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM C/R GNS II SZ4 RT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM C/R GNS II SZ6 RT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM C/R GNS II SZ6 RT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM C/R GNS II SZ7 RT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM C/R GNS II SZ7 RT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM DIS EDG HK LGN SZ 3 5MM
|
Facility
|
OP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem Medicaid |
$3,017.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Humana KY Medicaid |
$3,017.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 3 5MM
|
Facility
|
IP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 4 10MM
|
Facility
|
IP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 4 10MM
|
Facility
|
OP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem Medicaid |
$3,017.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Humana KY Medicaid |
$3,017.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 4 15MM
|
Facility
|
IP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 4 15MM
|
Facility
|
OP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem Medicaid |
$3,017.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Humana KY Medicaid |
$3,017.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 4 5MM
|
Facility
|
OP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem Medicaid |
$3,017.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Humana KY Medicaid |
$3,017.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 4 5MM
|
Facility
|
IP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
|
FEM DIS EDG HK LGN SZ 5 10MM
|
Facility
|
IP
|
$8,774.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,632.29 |
| Max. Negotiated Rate |
$8,423.33 |
| Rate for Payer: Aetna Commercial |
$6,756.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.95
|
| Rate for Payer: Cash Price |
$4,387.15
|
| Rate for Payer: Cigna Commercial |
$7,282.67
|
| Rate for Payer: First Health Commercial |
$8,335.58
|
| Rate for Payer: Humana Commercial |
$7,458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,019.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,054.27
|
| Rate for Payer: PHCS Commercial |
$8,423.33
|
| Rate for Payer: United Healthcare All Payer |
$7,721.38
|
|
