|
FEM NAR JRNY COCR BSC SZ 6 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 6 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 6 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 6 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
|
|
|
FEM NAR JRNY COCR BSC SZ 7 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 7 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 7 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
|
|
|
FEM NAR JRNY COCR BSC SZ 7 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 NARROW CR NP SZ 3 LT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 3 LT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 3 RT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 3 RT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 4 LT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 4 LT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 4 RT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 4 RT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 5 LT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 5 LT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 5 RT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 5 RT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 6 LT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 6 LT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 6 RT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW CR NP SZ 6 RT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
FEM NARROW PS NP SZ 3 LT
|
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
|
|
