|
FEM POROUS GII P/S HA S6 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 POROUS GII P/S HA S6 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 POROUS GII P/S HA S6 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 POROUS GII P/S HA S7 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 POROUS GII P/S HA S7 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 POROUS GII P/S HA S7 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 POROUS GII P/S HA S7 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 POROUS GII P/S HA S8 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 POROUS GII P/S HA S8 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 POROUS GII P/S HA S8 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 POROUS GII P/S HA S8 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 POST WDG G2 5-6 5LG
|
Facility
|
IP
|
$7,911.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.32 |
| Max. Negotiated Rate |
$7,594.64 |
| Rate for Payer: Aetna Commercial |
$6,091.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,170.64
|
| Rate for Payer: Cash Price |
$3,955.54
|
| Rate for Payer: Cigna Commercial |
$6,566.20
|
| Rate for Payer: First Health Commercial |
$7,515.53
|
| Rate for Payer: Humana Commercial |
$6,724.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,487.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,838.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,961.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.65
|
| Rate for Payer: PHCS Commercial |
$7,594.64
|
| Rate for Payer: United Healthcare All Payer |
$6,961.75
|
|
|
FEM POST WDG G2 5-6 5LG
|
Facility
|
OP
|
$7,911.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.32 |
| Max. Negotiated Rate |
$7,594.64 |
| Rate for Payer: Aetna Commercial |
$6,091.53
|
| Rate for Payer: Anthem Medicaid |
$2,720.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,170.64
|
| Rate for Payer: Cash Price |
$3,955.54
|
| Rate for Payer: Cigna Commercial |
$6,566.20
|
| Rate for Payer: First Health Commercial |
$7,515.53
|
| Rate for Payer: Humana Commercial |
$6,724.42
|
| Rate for Payer: Humana KY Medicaid |
$2,720.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,748.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,487.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,838.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,961.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.65
|
| Rate for Payer: PHCS Commercial |
$7,594.64
|
| Rate for Payer: United Healthcare All Payer |
$6,961.75
|
|
|
FEM POST WDG G2 7-8 5XS
|
Facility
|
IP
|
$7,911.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.32 |
| Max. Negotiated Rate |
$7,594.64 |
| Rate for Payer: Aetna Commercial |
$6,091.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,170.64
|
| Rate for Payer: Cash Price |
$3,955.54
|
| Rate for Payer: Cigna Commercial |
$6,566.20
|
| Rate for Payer: First Health Commercial |
$7,515.53
|
| Rate for Payer: Humana Commercial |
$6,724.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,487.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,838.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,961.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.65
|
| Rate for Payer: PHCS Commercial |
$7,594.64
|
| Rate for Payer: United Healthcare All Payer |
$6,961.75
|
|
|
FEM POST WDG G2 7-8 5XS
|
Facility
|
OP
|
$7,911.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.32 |
| Max. Negotiated Rate |
$7,594.64 |
| Rate for Payer: Aetna Commercial |
$6,091.53
|
| Rate for Payer: Anthem Medicaid |
$2,720.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,170.64
|
| Rate for Payer: Cash Price |
$3,955.54
|
| Rate for Payer: Cigna Commercial |
$6,566.20
|
| Rate for Payer: First Health Commercial |
$7,515.53
|
| Rate for Payer: Humana Commercial |
$6,724.42
|
| Rate for Payer: Humana KY Medicaid |
$2,720.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,748.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,487.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,838.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,961.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,933.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,328.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,458.65
|
| Rate for Payer: PHCS Commercial |
$7,594.64
|
| Rate for Payer: United Healthcare All Payer |
$6,961.75
|
|
|
FEM PROX ELLIP OSS 7CM L
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX ELLIP OSS 7CM L
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX ELLIP OSS 7CM R
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX ELLIP OSS 7CM R
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX LOW-PROFILE OSS L
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX LOW-PROFILE OSS L
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX LOW-PROFILE OSS R
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX LOW-PROFILE OSS R
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX OSS FINN MOD 7CM L
|
Facility
|
IP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
|
FEM PROX OSS FINN MOD 7CM L
|
Facility
|
OP
|
$70,996.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,298.80 |
| Max. Negotiated Rate |
$68,156.16 |
| Rate for Payer: Aetna Commercial |
$54,666.92
|
| Rate for Payer: Anthem Medicaid |
$24,415.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,376.88
|
| Rate for Payer: Cash Price |
$35,498.00
|
| Rate for Payer: Cigna Commercial |
$58,926.68
|
| Rate for Payer: First Health Commercial |
$67,446.20
|
| Rate for Payer: Humana Commercial |
$60,346.60
|
| Rate for Payer: Humana KY Medicaid |
$24,415.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,664.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,216.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,395.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,298.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,905.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,476.48
|
| Rate for Payer: Ohio Health Group HMO |
$53,247.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,796.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,766.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,987.24
|
| Rate for Payer: PHCS Commercial |
$68,156.16
|
| Rate for Payer: United Healthcare All Payer |
$62,476.48
|
|
