|
FEM GNS C/R II SZ6 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 SZ6 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 SZ7 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 SZ7 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 SZ8 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 SZ8 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 HD ZIRC 10/12 22MM -3 EXT
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
FEM HD ZIRC 10/12 22MM -3 EXT
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
FEM HD ZIRC 10/12 26MM +0 EXT
|
Facility
|
IP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 26MM +0 EXT
|
Facility
|
OP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem Medicaid |
$3,096.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Humana KY Medicaid |
$3,096.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,127.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 26MM +5 EXT
|
Facility
|
IP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 26MM +5 EXT
|
Facility
|
OP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem Medicaid |
$3,096.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Humana KY Medicaid |
$3,096.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,127.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 26MM -5 EXT
|
Facility
|
IP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 26MM -5 EXT
|
Facility
|
OP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem Medicaid |
$3,096.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Humana KY Medicaid |
$3,096.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,127.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 28MM +0 EXT
|
Facility
|
IP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 28MM +0 EXT
|
Facility
|
OP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem Medicaid |
$3,096.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Humana KY Medicaid |
$3,096.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,127.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 28MM +5 EXT
|
Facility
|
IP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 28MM +5 EXT
|
Facility
|
OP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem Medicaid |
$3,096.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Humana KY Medicaid |
$3,096.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,127.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 28MM -5 EXT
|
Facility
|
OP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem Medicaid |
$3,096.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Humana KY Medicaid |
$3,096.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,127.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,158.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HD ZIRC 10/12 28MM -5 EXT
|
Facility
|
IP
|
$9,003.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.00 |
| Max. Negotiated Rate |
$8,643.21 |
| Rate for Payer: Aetna Commercial |
$6,932.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,022.61
|
| Rate for Payer: Cash Price |
$4,501.67
|
| Rate for Payer: Cigna Commercial |
$7,472.77
|
| Rate for Payer: First Health Commercial |
$8,553.17
|
| Rate for Payer: Humana Commercial |
$7,652.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,382.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,644.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,701.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,922.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,752.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,202.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,832.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,212.30
|
| Rate for Payer: PHCS Commercial |
$8,643.21
|
| Rate for Payer: United Healthcare All Payer |
$7,922.94
|
|
|
FEM HEAD TPR +16 12/14 36MM
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
FEM HEAD TPR +16 12/14 36MM
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
FEM HEAD TRAIL 12/14 32MM +16
|
Facility
|
OP
|
$1,939.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.86 |
| Max. Negotiated Rate |
$1,861.96 |
| Rate for Payer: Aetna Commercial |
$1,493.45
|
| Rate for Payer: Anthem Medicaid |
$667.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,512.84
|
| Rate for Payer: Cash Price |
$969.77
|
| Rate for Payer: Cigna Commercial |
$1,609.82
|
| Rate for Payer: First Health Commercial |
$1,842.56
|
| Rate for Payer: Humana Commercial |
$1,648.61
|
| Rate for Payer: Humana KY Medicaid |
$667.01
|
| Rate for Payer: Kentucky WC Medicaid |
$673.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,706.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,454.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,551.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,687.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.28
|
| Rate for Payer: PHCS Commercial |
$1,861.96
|
| Rate for Payer: United Healthcare All Payer |
$1,706.80
|
|
|
FEM HEAD TRAIL 12/14 32MM +16
|
Facility
|
IP
|
$1,939.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.86 |
| Max. Negotiated Rate |
$1,861.96 |
| Rate for Payer: Aetna Commercial |
$1,493.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,512.84
|
| Rate for Payer: Cash Price |
$969.77
|
| Rate for Payer: Cigna Commercial |
$1,609.82
|
| Rate for Payer: First Health Commercial |
$1,842.56
|
| Rate for Payer: Humana Commercial |
$1,648.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,590.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,431.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,706.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,454.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,551.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,687.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.28
|
| Rate for Payer: PHCS Commercial |
$1,861.96
|
| Rate for Payer: United Healthcare All Payer |
$1,706.80
|
|
|
FEM HEAD TRIAL V40 STANDARD
|
Facility
|
OP
|
$1,915.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.68 |
| Max. Negotiated Rate |
$1,838.98 |
| Rate for Payer: Aetna Commercial |
$1,475.01
|
| Rate for Payer: Anthem Medicaid |
$658.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.17
|
| Rate for Payer: Cash Price |
$957.80
|
| Rate for Payer: Cigna Commercial |
$1,589.95
|
| Rate for Payer: First Health Commercial |
$1,819.82
|
| Rate for Payer: Humana Commercial |
$1,628.26
|
| Rate for Payer: Humana KY Medicaid |
$658.77
|
| Rate for Payer: Kentucky WC Medicaid |
$665.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$671.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.76
|
| Rate for Payer: PHCS Commercial |
$1,838.98
|
| Rate for Payer: United Healthcare All Payer |
$1,685.73
|
|
