|
SRA/IPL LMTD FACLSR-PP#2/3 25%
|
Professional
|
Both
|
$159.00
|
|
| Hospital Charge Code |
22200453
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$111.30 |
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Multiplan PHCS |
$95.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.30
|
| Rate for Payer: UHCCP Medicaid |
$55.65
|
|
|
SRA/IPL SPOT LASER TX
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200172
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
SRA/IPL SPOT LASER TX
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
22200172
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.59
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
SRA/IPL SPOT LASER TX
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
22200172
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
SRA/IPL SPOT LSR-PP#1 50%
|
Professional
|
Both
|
$192.00
|
|
| Hospital Charge Code |
22200336
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
|
|
SRA/IPL SPOT LSR-PP#2/3 25%
|
Professional
|
Both
|
$95.00
|
|
| Hospital Charge Code |
22200452
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
|
|
SROM 11/13 40MM SPEC +0
|
Facility
|
IP
|
$9,018.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,705.44 |
| Max. Negotiated Rate |
$8,657.40 |
| Rate for Payer: Aetna Commercial |
$6,943.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,034.13
|
| Rate for Payer: Cash Price |
$4,509.06
|
| Rate for Payer: Cigna Commercial |
$7,485.04
|
| Rate for Payer: First Health Commercial |
$8,567.21
|
| Rate for Payer: Humana Commercial |
$7,665.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,394.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,655.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,705.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,935.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,763.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,214.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,845.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,222.50
|
| Rate for Payer: PHCS Commercial |
$8,657.40
|
| Rate for Payer: United Healthcare All Payer |
$7,935.95
|
|
|
SROM 11/13 40MM SPEC +0
|
Facility
|
OP
|
$9,018.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,705.44 |
| Max. Negotiated Rate |
$8,657.40 |
| Rate for Payer: Aetna Commercial |
$6,943.95
|
| Rate for Payer: Anthem Medicaid |
$3,101.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,034.13
|
| Rate for Payer: Cash Price |
$4,509.06
|
| Rate for Payer: Cigna Commercial |
$7,485.04
|
| Rate for Payer: First Health Commercial |
$8,567.21
|
| Rate for Payer: Humana Commercial |
$7,665.40
|
| Rate for Payer: Humana KY Medicaid |
$3,101.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,132.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,394.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,655.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,705.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,163.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,935.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,763.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,214.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,845.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,222.50
|
| Rate for Payer: PHCS Commercial |
$8,657.40
|
| Rate for Payer: United Healthcare All Payer |
$7,935.95
|
|
|
SROM 11/13 40MM SPEC +3
|
Facility
|
OP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem Medicaid |
$3,181.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Humana KY Medicaid |
$3,181.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,244.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 40MM SPEC +3
|
Facility
|
IP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 40MM SPEC -3
|
Facility
|
OP
|
$8,102.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.81 |
| Max. Negotiated Rate |
$7,778.59 |
| Rate for Payer: Aetna Commercial |
$6,239.08
|
| Rate for Payer: Anthem Medicaid |
$2,786.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.11
|
| Rate for Payer: Cash Price |
$4,051.35
|
| Rate for Payer: Cigna Commercial |
$6,725.24
|
| Rate for Payer: First Health Commercial |
$7,697.56
|
| Rate for Payer: Humana Commercial |
$6,887.30
|
| Rate for Payer: Humana KY Medicaid |
$2,786.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,814.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,979.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,842.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,130.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,482.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,049.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,590.86
|
| Rate for Payer: PHCS Commercial |
$7,778.59
|
| Rate for Payer: United Healthcare All Payer |
$7,130.38
|
|
|
SROM 11/13 40MM SPEC -3
|
Facility
|
IP
|
$8,102.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.81 |
| Max. Negotiated Rate |
$7,778.59 |
| Rate for Payer: Aetna Commercial |
$6,239.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.11
|
| Rate for Payer: Cash Price |
$4,051.35
|
| Rate for Payer: Cigna Commercial |
$6,725.24
|
| Rate for Payer: First Health Commercial |
$7,697.56
|
| Rate for Payer: Humana Commercial |
$6,887.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,979.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,130.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,482.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,049.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,590.86
|
| Rate for Payer: PHCS Commercial |
$7,778.59
|
| Rate for Payer: United Healthcare All Payer |
$7,130.38
|
|
|
SROM 11/13 40MM SPEC +6
|
Facility
|
IP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 40MM SPEC +6
|
Facility
|
OP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem Medicaid |
$3,181.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Humana KY Medicaid |
$3,181.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,244.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +0
|
Facility
|
OP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem Medicaid |
$3,181.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Humana KY Medicaid |
$3,181.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,244.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +0
|
Facility
|
IP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +12
|
Facility
|
OP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem Medicaid |
$3,181.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Humana KY Medicaid |
$3,181.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,244.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +12
|
Facility
|
IP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +3
|
Facility
|
IP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +3
|
Facility
|
OP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem Medicaid |
$3,181.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Humana KY Medicaid |
$3,181.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,244.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC -3
|
Facility
|
IP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC -3
|
Facility
|
OP
|
$9,250.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,775.08 |
| Max. Negotiated Rate |
$8,880.25 |
| Rate for Payer: Aetna Commercial |
$7,122.70
|
| Rate for Payer: Anthem Medicaid |
$3,181.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,215.20
|
| Rate for Payer: Cash Price |
$4,625.13
|
| Rate for Payer: Cigna Commercial |
$7,677.72
|
| Rate for Payer: First Health Commercial |
$8,787.75
|
| Rate for Payer: Humana Commercial |
$7,862.72
|
| Rate for Payer: Humana KY Medicaid |
$3,181.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,585.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,826.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,244.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,140.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,400.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,047.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,382.68
|
| Rate for Payer: PHCS Commercial |
$8,880.25
|
| Rate for Payer: United Healthcare All Payer |
$8,140.23
|
|
|
SROM 11/13 44MM SPEC +6
|
Facility
|
OP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem Medicaid |
$4,257.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Humana KY Medicaid |
$4,257.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,301.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,343.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
|
SROM 11/13 44MM SPEC +6
|
Facility
|
IP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
|
SROM 11/13 44MM SPEC +9
|
Facility
|
IP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
