|
REF FSO 3 44MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 3 44MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 46MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 46MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 48MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 48MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 50MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 50MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 52MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 52MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 54MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 54MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 56MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 56MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 58MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 58MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 60MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 60MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 62MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 62MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 64MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 64MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 5 66MM OD
|
Facility
|
IP
|
$9,606.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.90 |
| Max. Negotiated Rate |
$9,222.61 |
| Rate for Payer: Aetna Commercial |
$7,397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.37
|
| Rate for Payer: Cash Price |
$4,803.44
|
| Rate for Payer: Cigna Commercial |
$7,973.72
|
| Rate for Payer: First Health Commercial |
$9,126.55
|
| Rate for Payer: Humana Commercial |
$8,165.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,882.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,454.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,205.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.14
|
| Rate for Payer: PHCS Commercial |
$9,222.61
|
| Rate for Payer: United Healthcare All Payer |
$8,454.06
|
|
|
REF FSO 5 66MM OD
|
Facility
|
OP
|
$9,606.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.90 |
| Max. Negotiated Rate |
$9,222.61 |
| Rate for Payer: Aetna Commercial |
$7,397.31
|
| Rate for Payer: Anthem Medicaid |
$3,303.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.37
|
| Rate for Payer: Cash Price |
$4,803.44
|
| Rate for Payer: Cigna Commercial |
$7,973.72
|
| Rate for Payer: First Health Commercial |
$9,126.55
|
| Rate for Payer: Humana Commercial |
$8,165.86
|
| Rate for Payer: Humana KY Medicaid |
$3,303.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,882.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,370.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,454.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,205.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.14
|
| Rate for Payer: PHCS Commercial |
$9,222.61
|
| Rate for Payer: United Healthcare All Payer |
$8,454.06
|
|
|
REF FSO 5 68MM OD
|
Facility
|
OP
|
$9,606.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.90 |
| Max. Negotiated Rate |
$9,222.61 |
| Rate for Payer: Aetna Commercial |
$7,397.31
|
| Rate for Payer: Anthem Medicaid |
$3,303.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.37
|
| Rate for Payer: Cash Price |
$4,803.44
|
| Rate for Payer: Cigna Commercial |
$7,973.72
|
| Rate for Payer: First Health Commercial |
$9,126.55
|
| Rate for Payer: Humana Commercial |
$8,165.86
|
| Rate for Payer: Humana KY Medicaid |
$3,303.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,882.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,370.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,454.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,205.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.14
|
| Rate for Payer: PHCS Commercial |
$9,222.61
|
| Rate for Payer: United Healthcare All Payer |
$8,454.06
|
|
