|
FEM NEXGEN PRECOAT LPS D-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-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 E-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 E-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 E-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 E-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 F-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 F-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 F-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 F-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 G-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 G-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 G-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 G-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 NONPOROUS GII PS SZ 1 LT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 1 LT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 1 RT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 1 RT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 2 LT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 2 LT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 2 RT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 2 RT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 3 LT
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 3 LT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
FEM NONPOROUS GII PS SZ 3 RT
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
