|
FEM DIS EDG HK LGN SZ 5 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 5 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 5 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 6 10MM
|
Facility
|
OP
|
$8,391.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.32 |
| Max. Negotiated Rate |
$8,055.41 |
| Rate for Payer: Aetna Commercial |
$6,461.11
|
| Rate for Payer: Anthem Medicaid |
$2,885.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,545.02
|
| Rate for Payer: Cash Price |
$4,195.52
|
| Rate for Payer: Cigna Commercial |
$6,964.57
|
| Rate for Payer: First Health Commercial |
$7,971.50
|
| Rate for Payer: Humana Commercial |
$7,132.39
|
| Rate for Payer: Humana KY Medicaid |
$2,885.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,915.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,880.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,192.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,943.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,384.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,293.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,712.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,789.82
|
| Rate for Payer: PHCS Commercial |
$8,055.41
|
| Rate for Payer: United Healthcare All Payer |
$7,384.12
|
|
|
FEM DIS EDG HK LGN SZ 6 10MM
|
Facility
|
IP
|
$8,391.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.32 |
| Max. Negotiated Rate |
$8,055.41 |
| Rate for Payer: Aetna Commercial |
$6,461.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,545.02
|
| Rate for Payer: Cash Price |
$4,195.52
|
| Rate for Payer: Cigna Commercial |
$6,964.57
|
| Rate for Payer: First Health Commercial |
$7,971.50
|
| Rate for Payer: Humana Commercial |
$7,132.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,880.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,192.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,384.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,293.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,712.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,789.82
|
| Rate for Payer: PHCS Commercial |
$8,055.41
|
| Rate for Payer: United Healthcare All Payer |
$7,384.12
|
|
|
FEM DIS EDG HK LGN SZ 6 15MM
|
Facility
|
OP
|
$8,391.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.32 |
| Max. Negotiated Rate |
$8,055.41 |
| Rate for Payer: Aetna Commercial |
$6,461.11
|
| Rate for Payer: Anthem Medicaid |
$2,885.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,545.02
|
| Rate for Payer: Cash Price |
$4,195.52
|
| Rate for Payer: Cigna Commercial |
$6,964.57
|
| Rate for Payer: First Health Commercial |
$7,971.50
|
| Rate for Payer: Humana Commercial |
$7,132.39
|
| Rate for Payer: Humana KY Medicaid |
$2,885.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,915.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,880.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,192.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,943.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,384.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,293.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,712.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,789.82
|
| Rate for Payer: PHCS Commercial |
$8,055.41
|
| Rate for Payer: United Healthcare All Payer |
$7,384.12
|
|
|
FEM DIS EDG HK LGN SZ 6 15MM
|
Facility
|
IP
|
$8,391.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.32 |
| Max. Negotiated Rate |
$8,055.41 |
| Rate for Payer: Aetna Commercial |
$6,461.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,545.02
|
| Rate for Payer: Cash Price |
$4,195.52
|
| Rate for Payer: Cigna Commercial |
$6,964.57
|
| Rate for Payer: First Health Commercial |
$7,971.50
|
| Rate for Payer: Humana Commercial |
$7,132.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,880.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,192.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,384.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,293.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,712.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,789.82
|
| Rate for Payer: PHCS Commercial |
$8,055.41
|
| Rate for Payer: United Healthcare All Payer |
$7,384.12
|
|
|
FEM DIS EDG HK LGN SZ 6 5MM
|
Facility
|
OP
|
$8,391.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.32 |
| Max. Negotiated Rate |
$8,055.41 |
| Rate for Payer: Aetna Commercial |
$6,461.11
|
| Rate for Payer: Anthem Medicaid |
$2,885.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,545.02
|
| Rate for Payer: Cash Price |
$4,195.52
|
| Rate for Payer: Cigna Commercial |
$6,964.57
|
| Rate for Payer: First Health Commercial |
$7,971.50
|
| Rate for Payer: Humana Commercial |
$7,132.39
|
| Rate for Payer: Humana KY Medicaid |
$2,885.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,915.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,880.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,192.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,943.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,384.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,293.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,712.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,789.82
|
| Rate for Payer: PHCS Commercial |
$8,055.41
|
| Rate for Payer: United Healthcare All Payer |
$7,384.12
|
|
|
FEM DIS EDG HK LGN SZ 6 5MM
|
Facility
|
IP
|
$8,391.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,517.32 |
| Max. Negotiated Rate |
$8,055.41 |
| Rate for Payer: Aetna Commercial |
$6,461.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,545.02
|
| Rate for Payer: Cash Price |
$4,195.52
|
| Rate for Payer: Cigna Commercial |
$6,964.57
|
| Rate for Payer: First Health Commercial |
$7,971.50
|
| Rate for Payer: Humana Commercial |
$7,132.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,880.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,192.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,517.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,384.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,293.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,712.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,789.82
|
| Rate for Payer: PHCS Commercial |
$8,055.41
|
| Rate for Payer: United Healthcare All Payer |
$7,384.12
|
|
|
FEM DIS EDG HK LGN SZ 7 10MM
|
Facility
|
OP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem Medicaid |
$2,784.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Humana KY Medicaid |
$2,784.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,812.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,840.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 10MM
|
Facility
|
IP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 15MM
|
Facility
|
OP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem Medicaid |
$2,784.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Humana KY Medicaid |
$2,784.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,812.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,840.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 15MM
|
Facility
|
IP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 20M
|
Facility
|
IP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 20M
|
Facility
|
OP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem Medicaid |
$2,784.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Humana KY Medicaid |
$2,784.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,812.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,840.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 5MM
|
Facility
|
OP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem Medicaid |
$2,784.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Humana KY Medicaid |
$2,784.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,812.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,840.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIS EDG HK LGN SZ 7 5MM
|
Facility
|
IP
|
$8,097.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,429.17 |
| Max. Negotiated Rate |
$7,773.34 |
| Rate for Payer: Aetna Commercial |
$6,234.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,315.84
|
| Rate for Payer: Cash Price |
$4,048.61
|
| Rate for Payer: Cigna Commercial |
$6,720.70
|
| Rate for Payer: First Health Commercial |
$7,692.37
|
| Rate for Payer: Humana Commercial |
$6,882.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,639.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,975.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,429.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,125.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,072.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,477.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,044.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,587.09
|
| Rate for Payer: PHCS Commercial |
$7,773.34
|
| Rate for Payer: United Healthcare All Payer |
$7,125.56
|
|
|
FEM DIST AUG HINGE
|
Facility
|
IP
|
$9,706.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,912.06 |
| Max. Negotiated Rate |
$9,318.60 |
| Rate for Payer: Aetna Commercial |
$7,474.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,571.37
|
| Rate for Payer: Cash Price |
$4,853.44
|
| Rate for Payer: Cigna Commercial |
$8,056.71
|
| Rate for Payer: First Health Commercial |
$9,221.54
|
| Rate for Payer: Humana Commercial |
$8,250.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,959.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,163.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,912.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,542.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,280.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,444.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,697.75
|
| Rate for Payer: PHCS Commercial |
$9,318.60
|
| Rate for Payer: United Healthcare All Payer |
$8,542.05
|
|
|
FEM DIST AUG HINGE
|
Facility
|
OP
|
$9,706.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,912.06 |
| Max. Negotiated Rate |
$9,318.60 |
| Rate for Payer: Aetna Commercial |
$7,474.30
|
| Rate for Payer: Anthem Medicaid |
$3,338.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,571.37
|
| Rate for Payer: Cash Price |
$4,853.44
|
| Rate for Payer: Cigna Commercial |
$8,056.71
|
| Rate for Payer: First Health Commercial |
$9,221.54
|
| Rate for Payer: Humana Commercial |
$8,250.85
|
| Rate for Payer: Humana KY Medicaid |
$3,338.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,372.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,959.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,163.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,542.05
|
| Rate for Payer: Ohio Health Group HMO |
$7,280.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,444.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,697.75
|
| Rate for Payer: PHCS Commercial |
$9,318.60
|
| Rate for Payer: United Healthcare All Payer |
$8,542.05
|
|
|
FEM DIS W/P MAK OSS 5CM L
|
Facility
|
OP
|
$74,302.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,290.60 |
| Max. Negotiated Rate |
$71,329.92 |
| Rate for Payer: Aetna Commercial |
$57,212.54
|
| Rate for Payer: Anthem Medicaid |
$25,552.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,955.56
|
| Rate for Payer: Cash Price |
$37,151.00
|
| Rate for Payer: Cigna Commercial |
$61,670.66
|
| Rate for Payer: First Health Commercial |
$70,586.90
|
| Rate for Payer: Humana Commercial |
$63,156.70
|
| Rate for Payer: Humana KY Medicaid |
$25,552.46
|
| Rate for Payer: Kentucky WC Medicaid |
$25,812.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,927.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,834.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,290.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,065.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,385.76
|
| Rate for Payer: Ohio Health Group HMO |
$55,726.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,642.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,268.38
|
| Rate for Payer: PHCS Commercial |
$71,329.92
|
| Rate for Payer: United Healthcare All Payer |
$65,385.76
|
|
|
FEM DIS W/P MAK OSS 5CM L
|
Facility
|
IP
|
$74,302.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,290.60 |
| Max. Negotiated Rate |
$71,329.92 |
| Rate for Payer: Aetna Commercial |
$57,212.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,955.56
|
| Rate for Payer: Cash Price |
$37,151.00
|
| Rate for Payer: Cigna Commercial |
$61,670.66
|
| Rate for Payer: First Health Commercial |
$70,586.90
|
| Rate for Payer: Humana Commercial |
$63,156.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,927.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,834.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,290.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,385.76
|
| Rate for Payer: Ohio Health Group HMO |
$55,726.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,642.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,268.38
|
| Rate for Payer: PHCS Commercial |
$71,329.92
|
| Rate for Payer: United Healthcare All Payer |
$65,385.76
|
|
|
FEM DIS W/P MAK OSS 5CM R
|
Facility
|
OP
|
$74,302.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,290.60 |
| Max. Negotiated Rate |
$71,329.92 |
| Rate for Payer: Aetna Commercial |
$57,212.54
|
| Rate for Payer: Anthem Medicaid |
$25,552.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,955.56
|
| Rate for Payer: Cash Price |
$37,151.00
|
| Rate for Payer: Cigna Commercial |
$61,670.66
|
| Rate for Payer: First Health Commercial |
$70,586.90
|
| Rate for Payer: Humana Commercial |
$63,156.70
|
| Rate for Payer: Humana KY Medicaid |
$25,552.46
|
| Rate for Payer: Kentucky WC Medicaid |
$25,812.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,927.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,834.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,290.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,065.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,385.76
|
| Rate for Payer: Ohio Health Group HMO |
$55,726.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,642.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,268.38
|
| Rate for Payer: PHCS Commercial |
$71,329.92
|
| Rate for Payer: United Healthcare All Payer |
$65,385.76
|
|
|
FEM DIS W/P MAK OSS 5CM R
|
Facility
|
IP
|
$74,302.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,290.60 |
| Max. Negotiated Rate |
$71,329.92 |
| Rate for Payer: Aetna Commercial |
$57,212.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,955.56
|
| Rate for Payer: Cash Price |
$37,151.00
|
| Rate for Payer: Cigna Commercial |
$61,670.66
|
| Rate for Payer: First Health Commercial |
$70,586.90
|
| Rate for Payer: Humana Commercial |
$63,156.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,927.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,834.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,290.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,385.76
|
| Rate for Payer: Ohio Health Group HMO |
$55,726.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64,642.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,268.38
|
| Rate for Payer: PHCS Commercial |
$71,329.92
|
| Rate for Payer: United Healthcare All Payer |
$65,385.76
|
|
|
FEM DIS W/P MAK OSS 7CM E L
|
Facility
|
OP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem Medicaid |
$26,198.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Humana KY Medicaid |
$26,198.55
|
| Rate for Payer: Kentucky WC Medicaid |
$26,465.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,724.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
FEM DIS W/P MAK OSS 7CM E L
|
Facility
|
IP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
