|
FEM NARROW PS NP SZ 3 LT
|
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 NARROW PS NP SZ 3 RT
|
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 NARROW PS NP SZ 3 RT
|
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 NARROW PS NP SZ 4 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
|
|
|
FEM NARROW PS NP SZ 4 LT
|
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 NARROW PS NP SZ 4 RT
|
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 NARROW PS NP SZ 4 RT
|
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 NARROW PS NP SZ 5 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
|
|
|
FEM NARROW PS NP SZ 5 LT
|
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 NARROW PS NP SZ 5 RT
|
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 NARROW PS NP SZ 5 RT
|
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 NARROW PS NP SZ 6 LT
|
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 NARROW PS NP SZ 6 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
|
|
|
FEM NARROW PS NP SZ 6 RT
|
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 NARROW PS NP SZ 6 RT
|
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 NEXGEN PRECOAT LPS B-LT
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS B-LT
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS B-RT
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS B-RT
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS C-LT
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS C-LT
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS C-RT
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS C-RT
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS D-LT
|
Facility
|
OP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem Medicaid |
$3,297.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Humana KY Medicaid |
$3,297.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,330.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,363.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
|
FEM NEXGEN PRECOAT LPS D-LT
|
Facility
|
IP
|
$9,588.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,876.47 |
| Max. Negotiated Rate |
$9,204.72 |
| Rate for Payer: Aetna Commercial |
$7,382.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,478.84
|
| Rate for Payer: Cash Price |
$4,794.12
|
| Rate for Payer: Cigna Commercial |
$7,958.25
|
| Rate for Payer: First Health Commercial |
$9,108.84
|
| Rate for Payer: Humana Commercial |
$8,150.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,862.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,076.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,876.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,437.66
|
| Rate for Payer: Ohio Health Group HMO |
$7,191.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,341.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,615.89
|
| Rate for Payer: PHCS Commercial |
$9,204.72
|
| Rate for Payer: United Healthcare All Payer |
$8,437.66
|
|
