|
REF FSO 5 68MM 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 70MM 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 70MM 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 9 50MM OD
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 50MM OD
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 52MM OD
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 52MM OD
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 70MM OD
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 70MM OD
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 72MM OD
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 72MM OD
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 74MM OD
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 74MM OD
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 76MM OD
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO 9 76MM OD
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REF FSO CER ACET COMP 46MM
|
Facility
|
IP
|
$11,614.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,509.91 |
| Max. Negotiated Rate |
$11,150.11 |
| Rate for Payer: Aetna Commercial |
$8,943.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,059.47
|
| Rate for Payer: Cash Price |
$5,807.35
|
| Rate for Payer: Cigna Commercial |
$9,640.20
|
| Rate for Payer: First Health Commercial |
$11,033.96
|
| Rate for Payer: Humana Commercial |
$9,872.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,524.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,571.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,484.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,220.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,711.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,322.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,600.56
|
| Rate for Payer: PHCS Commercial |
$11,150.11
|
| Rate for Payer: United Healthcare All Payer |
$10,220.94
|
|
|
REF FSO CER ACET COMP 46MM
|
Facility
|
OP
|
$11,614.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,509.91 |
| Max. Negotiated Rate |
$11,150.11 |
| Rate for Payer: Aetna Commercial |
$8,943.32
|
| Rate for Payer: Anthem Medicaid |
$3,994.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,059.47
|
| Rate for Payer: Cash Price |
$5,807.35
|
| Rate for Payer: Cigna Commercial |
$9,640.20
|
| Rate for Payer: First Health Commercial |
$11,033.96
|
| Rate for Payer: Humana Commercial |
$9,872.50
|
| Rate for Payer: Humana KY Medicaid |
$3,994.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,034.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,524.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,571.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,484.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,074.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,220.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,711.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,322.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,600.56
|
| Rate for Payer: PHCS Commercial |
$11,150.11
|
| Rate for Payer: United Healthcare All Payer |
$10,220.94
|
|
|
REF FSO CER ACET COMP 48MM
|
Facility
|
OP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem Medicaid |
$3,959.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Humana KY Medicaid |
$3,959.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,999.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,038.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
REF FSO CER ACET COMP 48MM
|
Facility
|
IP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
REF FSO CER ACET COMP 50MM
|
Facility
|
IP
|
$11,515.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.00 |
| Max. Negotiated Rate |
$11,054.80 |
| Rate for Payer: Aetna Commercial |
$8,866.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,982.03
|
| Rate for Payer: Cash Price |
$5,757.71
|
| Rate for Payer: Cigna Commercial |
$9,557.80
|
| Rate for Payer: First Health Commercial |
$10,939.65
|
| Rate for Payer: Humana Commercial |
$9,788.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,442.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,498.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,454.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,133.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,636.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.78
|
| Rate for Payer: PHCS Commercial |
$11,054.80
|
| Rate for Payer: United Healthcare All Payer |
$10,133.57
|
|
|
REF FSO CER ACET COMP 50MM
|
Facility
|
OP
|
$11,515.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.00 |
| Max. Negotiated Rate |
$11,054.80 |
| Rate for Payer: Aetna Commercial |
$8,866.87
|
| Rate for Payer: Anthem Medicaid |
$3,960.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,982.03
|
| Rate for Payer: Cash Price |
$5,757.71
|
| Rate for Payer: Cigna Commercial |
$9,557.80
|
| Rate for Payer: First Health Commercial |
$10,939.65
|
| Rate for Payer: Humana Commercial |
$9,788.11
|
| Rate for Payer: Humana KY Medicaid |
$3,960.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,000.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,442.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,498.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,454.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,039.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,133.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,636.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.78
|
| Rate for Payer: PHCS Commercial |
$11,054.80
|
| Rate for Payer: United Healthcare All Payer |
$10,133.57
|
|
|
REF FSO CER ACET COMP 54MM
|
Facility
|
OP
|
$11,515.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.00 |
| Max. Negotiated Rate |
$11,054.80 |
| Rate for Payer: Aetna Commercial |
$8,866.87
|
| Rate for Payer: Anthem Medicaid |
$3,960.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,982.03
|
| Rate for Payer: Cash Price |
$5,757.71
|
| Rate for Payer: Cigna Commercial |
$9,557.80
|
| Rate for Payer: First Health Commercial |
$10,939.65
|
| Rate for Payer: Humana Commercial |
$9,788.11
|
| Rate for Payer: Humana KY Medicaid |
$3,960.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,000.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,442.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,498.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,454.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,039.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,133.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,636.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.78
|
| Rate for Payer: PHCS Commercial |
$11,054.80
|
| Rate for Payer: United Healthcare All Payer |
$10,133.57
|
|
|
REF FSO CER ACET COMP 54MM
|
Facility
|
IP
|
$11,515.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.00 |
| Max. Negotiated Rate |
$11,054.80 |
| Rate for Payer: Aetna Commercial |
$8,866.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,982.03
|
| Rate for Payer: Cash Price |
$5,757.71
|
| Rate for Payer: Cigna Commercial |
$9,557.80
|
| Rate for Payer: First Health Commercial |
$10,939.65
|
| Rate for Payer: Humana Commercial |
$9,788.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,442.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,498.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,454.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,133.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,636.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.78
|
| Rate for Payer: PHCS Commercial |
$11,054.80
|
| Rate for Payer: United Healthcare All Payer |
$10,133.57
|
|
|
REF FSO CER ACET COMP 56MM
|
Facility
|
IP
|
$11,515.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.00 |
| Max. Negotiated Rate |
$11,054.80 |
| Rate for Payer: Aetna Commercial |
$8,866.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,982.03
|
| Rate for Payer: Cash Price |
$5,757.71
|
| Rate for Payer: Cigna Commercial |
$9,557.80
|
| Rate for Payer: First Health Commercial |
$10,939.65
|
| Rate for Payer: Humana Commercial |
$9,788.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,442.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,498.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,454.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,133.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,636.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.78
|
| Rate for Payer: PHCS Commercial |
$11,054.80
|
| Rate for Payer: United Healthcare All Payer |
$10,133.57
|
|
|
REF FSO CER ACET COMP 56MM
|
Facility
|
OP
|
$11,515.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.00 |
| Max. Negotiated Rate |
$11,054.80 |
| Rate for Payer: Aetna Commercial |
$8,866.87
|
| Rate for Payer: Anthem Medicaid |
$3,960.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,982.03
|
| Rate for Payer: Cash Price |
$5,757.71
|
| Rate for Payer: Cigna Commercial |
$9,557.80
|
| Rate for Payer: First Health Commercial |
$10,939.65
|
| Rate for Payer: Humana Commercial |
$9,788.11
|
| Rate for Payer: Humana KY Medicaid |
$3,960.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,000.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,442.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,498.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,454.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,039.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,133.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,636.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,303.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.78
|
| Rate for Payer: PHCS Commercial |
$11,054.80
|
| Rate for Payer: United Healthcare All Payer |
$10,133.57
|
|
