|
REF FSO CER ACET COMP 58MM
|
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 58MM
|
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 60MM
|
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 60MM
|
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 62MM
|
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 62MM
|
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 64MM
|
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 64MM
|
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 66MM
|
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 66MM
|
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 HA 3H SZ 42MM B
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 42MM B
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 44MM C
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 44MM C
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 46MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 46MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 48MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 48MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 50MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 50MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 52MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 52MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 54MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 54MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
REF HA 3H SZ 56MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
