|
REF FSO 5 66MM OD
|
Facility
|
OP
|
$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 Medicaid |
$3,372.59
|
| 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: Humana KY Medicaid |
$3,372.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.91
|
| 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: Molina Healthcare Medicaid |
$3,440.26
|
| 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
|
|
|
REF FSO 5 68MM OD
|
Facility
|
OP
|
$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 Medicaid |
$3,372.59
|
| 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: Humana KY Medicaid |
$3,372.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.91
|
| 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: Molina Healthcare Medicaid |
$3,440.26
|
| 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
|
|
|
REF FSO 5 68MM 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
|
|
|
REF FSO 5 70MM OD
|
Facility
|
OP
|
$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 Medicaid |
$3,372.59
|
| 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: Humana KY Medicaid |
$3,372.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.91
|
| 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: Molina Healthcare Medicaid |
$3,440.26
|
| 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
|
|
|
REF FSO 5 70MM 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
|
|
|
REF FSO 9 50MM OD
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 50MM OD
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 52MM OD
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 52MM OD
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 70MM OD
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 70MM OD
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 72MM OD
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 72MM OD
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 74MM OD
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 74MM OD
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 76MM OD
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO 9 76MM OD
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REF FSO CER ACET COMP 46MM
|
Facility
|
OP
|
$11,860.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,558.08 |
| Max. Negotiated Rate |
$11,385.85 |
| Rate for Payer: Aetna Commercial |
$9,132.40
|
| Rate for Payer: Anthem Medicaid |
$4,078.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,251.00
|
| Rate for Payer: Cash Price |
$5,930.13
|
| Rate for Payer: Cigna Commercial |
$9,844.02
|
| Rate for Payer: First Health Commercial |
$11,267.25
|
| Rate for Payer: Humana Commercial |
$10,081.22
|
| Rate for Payer: Humana KY Medicaid |
$4,078.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,120.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,725.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,558.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,160.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,437.03
|
| Rate for Payer: Ohio Health Group HMO |
$8,895.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,488.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,318.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,183.58
|
| Rate for Payer: PHCS Commercial |
$11,385.85
|
| Rate for Payer: United Healthcare All Payer |
$10,437.03
|
|
|
REF FSO CER ACET COMP 46MM
|
Facility
|
IP
|
$11,860.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,558.08 |
| Max. Negotiated Rate |
$11,385.85 |
| Rate for Payer: Aetna Commercial |
$9,132.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,251.00
|
| Rate for Payer: Cash Price |
$5,930.13
|
| Rate for Payer: Cigna Commercial |
$9,844.02
|
| Rate for Payer: First Health Commercial |
$11,267.25
|
| Rate for Payer: Humana Commercial |
$10,081.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,725.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,752.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,558.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,437.03
|
| Rate for Payer: Ohio Health Group HMO |
$8,895.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,488.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,318.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,183.58
|
| Rate for Payer: PHCS Commercial |
$11,385.85
|
| Rate for Payer: United Healthcare All Payer |
$10,437.03
|
|
|
REF FSO CER ACET COMP 48MM
|
Facility
|
OP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem Medicaid |
$4,043.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Humana KY Medicaid |
$4,043.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,084.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
REF FSO CER ACET COMP 48MM
|
Facility
|
IP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
REF FSO CER ACET COMP 50MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF FSO CER ACET COMP 50MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF FSO CER ACET COMP 54MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF FSO CER ACET COMP 54MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
