|
FEM DIS W/P MAK RS OSS 8.5 R
|
Facility
|
OP
|
$73,376.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,012.90 |
| Max. Negotiated Rate |
$70,441.27 |
| Rate for Payer: Aetna Commercial |
$56,499.77
|
| Rate for Payer: Anthem Medicaid |
$25,234.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,233.53
|
| Rate for Payer: Cash Price |
$36,688.16
|
| Rate for Payer: Cigna Commercial |
$60,902.35
|
| Rate for Payer: First Health Commercial |
$69,707.50
|
| Rate for Payer: Humana Commercial |
$62,369.87
|
| Rate for Payer: Humana KY Medicaid |
$25,234.12
|
| Rate for Payer: Kentucky WC Medicaid |
$25,490.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,168.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,151.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,012.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,740.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,571.16
|
| Rate for Payer: Ohio Health Group HMO |
$55,032.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,701.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,837.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,629.66
|
| Rate for Payer: PHCS Commercial |
$70,441.27
|
| Rate for Payer: United Healthcare All Payer |
$64,571.16
|
|
|
FEM ELLIP OSS RS 7CM SEG L
|
Facility
|
OP
|
$75,259.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,577.88 |
| Max. Negotiated Rate |
$72,249.22 |
| Rate for Payer: Aetna Commercial |
$57,949.89
|
| Rate for Payer: Anthem Medicaid |
$25,881.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,702.49
|
| Rate for Payer: Cash Price |
$37,629.80
|
| Rate for Payer: Cigna Commercial |
$62,465.47
|
| Rate for Payer: First Health Commercial |
$71,496.62
|
| Rate for Payer: Humana Commercial |
$63,970.66
|
| Rate for Payer: Humana KY Medicaid |
$25,881.78
|
| Rate for Payer: Kentucky WC Medicaid |
$26,145.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,712.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,541.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,401.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,228.45
|
| Rate for Payer: Ohio Health Group HMO |
$56,444.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,207.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,475.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,929.12
|
| Rate for Payer: PHCS Commercial |
$72,249.22
|
| Rate for Payer: United Healthcare All Payer |
$66,228.45
|
|
|
FEM ELLIP OSS RS 7CM SEG L
|
Facility
|
IP
|
$75,259.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,577.88 |
| Max. Negotiated Rate |
$72,249.22 |
| Rate for Payer: Aetna Commercial |
$57,949.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,702.49
|
| Rate for Payer: Cash Price |
$37,629.80
|
| Rate for Payer: Cigna Commercial |
$62,465.47
|
| Rate for Payer: First Health Commercial |
$71,496.62
|
| Rate for Payer: Humana Commercial |
$63,970.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,712.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,541.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,228.45
|
| Rate for Payer: Ohio Health Group HMO |
$56,444.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,207.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,475.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,929.12
|
| Rate for Payer: PHCS Commercial |
$72,249.22
|
| Rate for Payer: United Healthcare All Payer |
$66,228.45
|
|
|
FEM ELLIP OSS RS 7CM SEG R
|
Facility
|
OP
|
$75,259.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,577.88 |
| Max. Negotiated Rate |
$72,249.22 |
| Rate for Payer: Aetna Commercial |
$57,949.89
|
| Rate for Payer: Anthem Medicaid |
$25,881.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,702.49
|
| Rate for Payer: Cash Price |
$37,629.80
|
| Rate for Payer: Cigna Commercial |
$62,465.47
|
| Rate for Payer: First Health Commercial |
$71,496.62
|
| Rate for Payer: Humana Commercial |
$63,970.66
|
| Rate for Payer: Humana KY Medicaid |
$25,881.78
|
| Rate for Payer: Kentucky WC Medicaid |
$26,145.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,712.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,541.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,401.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,228.45
|
| Rate for Payer: Ohio Health Group HMO |
$56,444.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,207.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,475.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,929.12
|
| Rate for Payer: PHCS Commercial |
$72,249.22
|
| Rate for Payer: United Healthcare All Payer |
$66,228.45
|
|
|
FEM ELLIP OSS RS 7CM SEG R
|
Facility
|
IP
|
$75,259.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,577.88 |
| Max. Negotiated Rate |
$72,249.22 |
| Rate for Payer: Aetna Commercial |
$57,949.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,702.49
|
| Rate for Payer: Cash Price |
$37,629.80
|
| Rate for Payer: Cigna Commercial |
$62,465.47
|
| Rate for Payer: First Health Commercial |
$71,496.62
|
| Rate for Payer: Humana Commercial |
$63,970.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,712.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,541.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,228.45
|
| Rate for Payer: Ohio Health Group HMO |
$56,444.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,207.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,475.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,929.12
|
| Rate for Payer: PHCS Commercial |
$72,249.22
|
| Rate for Payer: United Healthcare All Payer |
$66,228.45
|
|
|
FEM ELLIP OSS RS 8.5CM SEG L
|
Facility
|
IP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
FEM ELLIP OSS RS 8.5CM SEG L
|
Facility
|
OP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem Medicaid |
$26,846.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Humana KY Medicaid |
$26,846.21
|
| Rate for Payer: Kentucky WC Medicaid |
$27,119.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,384.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
FEM ELLIP OSS RS 8.5CM SEG R
|
Facility
|
OP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem Medicaid |
$26,846.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Humana KY Medicaid |
$26,846.21
|
| Rate for Payer: Kentucky WC Medicaid |
$27,119.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,384.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
FEM ELLIP OSS RS 8.5CM SEG R
|
Facility
|
IP
|
$78,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,419.20 |
| Max. Negotiated Rate |
$74,941.44 |
| Rate for Payer: Aetna Commercial |
$60,109.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,889.92
|
| Rate for Payer: Cash Price |
$39,032.00
|
| Rate for Payer: Cigna Commercial |
$64,793.12
|
| Rate for Payer: First Health Commercial |
$74,160.80
|
| Rate for Payer: Humana Commercial |
$66,354.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,012.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,611.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,419.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,696.32
|
| Rate for Payer: Ohio Health Group HMO |
$58,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,915.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,864.16
|
| Rate for Payer: PHCS Commercial |
$74,941.44
|
| Rate for Payer: United Healthcare All Payer |
$68,696.32
|
|
|
FEM EX SM STR 22MM HD 105
|
Facility
|
OP
|
$15,640.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,692.07 |
| Max. Negotiated Rate |
$15,014.62 |
| Rate for Payer: Aetna Commercial |
$12,042.98
|
| Rate for Payer: Anthem Medicaid |
$5,378.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,199.38
|
| Rate for Payer: Cash Price |
$7,820.12
|
| Rate for Payer: Cigna Commercial |
$12,981.39
|
| Rate for Payer: First Health Commercial |
$14,858.22
|
| Rate for Payer: Humana Commercial |
$13,294.20
|
| Rate for Payer: Humana KY Medicaid |
$5,378.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,433.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,824.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,542.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,692.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,486.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,763.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,730.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,512.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,607.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,791.76
|
| Rate for Payer: PHCS Commercial |
$15,014.62
|
| Rate for Payer: United Healthcare All Payer |
$13,763.40
|
|
|
FEM EX SM STR 22MM HD 105
|
Facility
|
IP
|
$15,640.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,692.07 |
| Max. Negotiated Rate |
$15,014.62 |
| Rate for Payer: Aetna Commercial |
$12,042.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,199.38
|
| Rate for Payer: Cash Price |
$7,820.12
|
| Rate for Payer: Cigna Commercial |
$12,981.39
|
| Rate for Payer: First Health Commercial |
$14,858.22
|
| Rate for Payer: Humana Commercial |
$13,294.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,824.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,542.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,692.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,763.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,730.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,512.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,607.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,791.76
|
| Rate for Payer: PHCS Commercial |
$15,014.62
|
| Rate for Payer: United Healthcare All Payer |
$13,763.40
|
|
|
FEM GNS C/R II SZ1 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 GNS C/R II SZ1 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 GNS C/R II SZ2 LT
|
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 GNS C/R II SZ2 LT
|
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 GNS C/R II SZ2 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 GNS C/R II SZ2 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 GNS C/R II SZ3 LT
|
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 GNS C/R II SZ3 LT
|
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 GNS C/R II SZ3 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 GNS C/R II SZ3 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 GNS C/R II SZ4 LT
|
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 GNS C/R II SZ4 LT
|
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 GNS C/R II SZ5 LT
|
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 GNS C/R II SZ5 LT
|
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
|
|
