|
REF FSO 3 42MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 3 42MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 3 44MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 3 44MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 46MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 46MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 48MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 48MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 50MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 50MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 52MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 52MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 54MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 54MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 56MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 56MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 58MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 58MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 60MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 60MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 62MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 62MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 64MM OD
|
Facility
|
OP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem Medicaid |
$3,149.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Humana KY Medicaid |
$3,149.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 64MM OD
|
Facility
|
IP
|
$9,158.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,747.54 |
| Max. Negotiated Rate |
$8,792.12 |
| Rate for Payer: Aetna Commercial |
$7,052.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.60
|
| Rate for Payer: Cash Price |
$4,579.23
|
| Rate for Payer: Cigna Commercial |
$7,601.52
|
| Rate for Payer: First Health Commercial |
$8,700.54
|
| Rate for Payer: Humana Commercial |
$7,784.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,326.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,967.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,319.34
|
| Rate for Payer: PHCS Commercial |
$8,792.12
|
| Rate for Payer: United Healthcare All Payer |
$8,059.44
|
|
|
REF FSO 5 66MM OD
|
Facility
|
IP
|
$9,806.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,942.07 |
| Max. Negotiated Rate |
$9,414.61 |
| Rate for Payer: Aetna Commercial |
$7,551.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.37
|
| Rate for Payer: Cash Price |
$4,903.44
|
| Rate for Payer: Cigna Commercial |
$8,139.72
|
| Rate for Payer: First Health Commercial |
$9,316.55
|
| Rate for Payer: Humana Commercial |
$8,335.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,942.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,630.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,355.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.75
|
| Rate for Payer: PHCS Commercial |
$9,414.61
|
| Rate for Payer: United Healthcare All Payer |
$8,630.06
|
|
