|
FEM JUNI FB COCR OX SZ 7 LM RL
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
FEM JUNI FB COCR OX SZ 7 RM LL
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
FEM JUNI FB COCR OX SZ 7 RM LL
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
FEM JUNI FB OX SZ 6 RM LL
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI FB OX SZ 6 RM LL
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI FB OX SZ 7 RM LL
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI FB OX SZ 7 RM LL
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI OX FB SZ 1 RM LL
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI OX FB SZ 1 RM LL
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI OX FB SZ 2 RM LL
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI OX FB SZ 2 RM LL
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI OX FB SZ 5 RM LL
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM JUNI OX FB SZ 5 RM LL
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
FEM MAXIM ILOK ANA PRI 60 RT
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
FEM MAXIM ILOK ANA PRI 60 RT
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
FEM MAXIM ILOK ANA PRI 65RT
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
FEM MAXIM ILOK ANA PRI 65RT
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
FEM MOD OSS RS 7CM SEG 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 MOD OSS RS 7CM SEG 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 MOD OSS RS 7CM SEG 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 MOD OSS RS 7CM SEG 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 NAR JRNY COCR BSC SZ 5 LT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
FEM NAR JRNY COCR BSC SZ 5 LT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
FEM NAR JRNY COCR BSC SZ 5 RT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
FEM NAR JRNY COCR BSC SZ 5 RT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
