|
REF INR 28ID 66-68OD ANT+4 SZJ
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF INR 28ID 66-68OD ANT+4 SZJ
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF INR 28ID 70-76OD ANT+4 SZK
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF INR 28ID 70-76OD ANT+4 SZK
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF INTERFIT THRD HOLE COVER
|
Facility
|
IP
|
$1,575.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.84 |
| Max. Negotiated Rate |
$1,512.68 |
| Rate for Payer: Aetna Commercial |
$1,213.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.05
|
| Rate for Payer: Cash Price |
$787.86
|
| Rate for Payer: Cigna Commercial |
$1,307.84
|
| Rate for Payer: First Health Commercial |
$1,496.92
|
| Rate for Payer: Humana Commercial |
$1,339.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.47
|
| Rate for Payer: PHCS Commercial |
$1,512.68
|
| Rate for Payer: United Healthcare All Payer |
$1,386.62
|
|
|
REF INTERFIT THRD HOLE COVER
|
Facility
|
OP
|
$1,575.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.84 |
| Max. Negotiated Rate |
$1,512.68 |
| Rate for Payer: Aetna Commercial |
$1,213.30
|
| Rate for Payer: Anthem Medicaid |
$541.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,229.05
|
| Rate for Payer: Cash Price |
$787.86
|
| Rate for Payer: Cigna Commercial |
$1,307.84
|
| Rate for Payer: First Health Commercial |
$1,496.92
|
| Rate for Payer: Humana Commercial |
$1,339.35
|
| Rate for Payer: Humana KY Medicaid |
$541.89
|
| Rate for Payer: Kentucky WC Medicaid |
$547.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,292.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.47
|
| Rate for Payer: PHCS Commercial |
$1,512.68
|
| Rate for Payer: United Healthcare All Payer |
$1,386.62
|
|
|
REF I POR ACET SHELL 42OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 42OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 44OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 44OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 46OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 46OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 48OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 48OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 50OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 50OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 52OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 52OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 54OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 54OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 56OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 56OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 58OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 58OD
|
Facility
|
OP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem Medicaid |
$3,937.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Humana KY Medicaid |
$3,937.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,977.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,016.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
|
REF I POR ACET SHELL 60OD
|
Facility
|
IP
|
$11,450.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.54 |
| Max. Negotiated Rate |
$10,992.26 |
| Rate for Payer: Aetna Commercial |
$8,816.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,931.21
|
| Rate for Payer: Cash Price |
$5,725.13
|
| Rate for Payer: Cigna Commercial |
$9,503.72
|
| Rate for Payer: First Health Commercial |
$10,877.76
|
| Rate for Payer: Humana Commercial |
$9,732.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,389.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,450.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,435.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,587.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,290.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,549.58
|
| Rate for Payer: PHCS Commercial |
$10,992.26
|
| Rate for Payer: United Healthcare All Payer |
$10,076.24
|
|
