|
FEMR PSN MCVE ASF R 18 8-11 GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 4-5/EF
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 4-5/EF
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 6-7/CD
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 6-7/CD
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 6-7/EF
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 6-7/EF
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSNMCVE ASF R 18M 8-11 EF
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSNMCVE ASF R 18M 8-11 EF
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 8-9/CD
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 18M 8-9/CD
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20 8-11 GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20 8-11 GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 4-5/EF
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 4-5/EF
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 6-7/CD
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 6-7/CD
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 6-7/EF
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 6-7/EF
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSNMCVE ASF R 20M 8-11 EF
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSNMCVE ASF R 20M 8-11 EF
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 8-9/CD
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEMR PSN MCVE ASF R 20M 8-9/CD
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
FEM SYNERGY PC 9 85MM
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
FEM SYNERGY PC 9 85MM
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
