|
REFL HA MH SHELL 64MM H
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 64MM H
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 66MM J
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 66MM J
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 68MM J
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 68MM J
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA PER HOLE SZ 54D
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA PER HOLE SZ 54D
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA PER HOLE SZ 56D
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA PER HOLE SZ 56D
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA PER HOLE SZ 58E
|
Facility
|
IP
|
$12,080.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.41 |
| Max. Negotiated Rate |
$11,596.88 |
| Rate for Payer: Aetna Commercial |
$9,301.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,422.46
|
| Rate for Payer: Cash Price |
$6,040.04
|
| Rate for Payer: Cigna Commercial |
$10,026.47
|
| Rate for Payer: First Health Commercial |
$11,476.08
|
| Rate for Payer: Humana Commercial |
$10,268.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,905.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,624.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,630.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,060.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,570.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.82
|
| Rate for Payer: PHCS Commercial |
$11,596.88
|
| Rate for Payer: United Healthcare All Payer |
$10,630.47
|
|
|
REFL HA PER HOLE SZ 58E
|
Facility
|
OP
|
$12,080.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.41 |
| Max. Negotiated Rate |
$11,596.88 |
| Rate for Payer: Aetna Commercial |
$9,301.66
|
| Rate for Payer: Anthem Medicaid |
$4,154.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,422.46
|
| Rate for Payer: Cash Price |
$6,040.04
|
| Rate for Payer: Cigna Commercial |
$10,026.47
|
| Rate for Payer: First Health Commercial |
$11,476.08
|
| Rate for Payer: Humana Commercial |
$10,268.07
|
| Rate for Payer: Humana KY Medicaid |
$4,154.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,196.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,905.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,624.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,237.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,630.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,060.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,570.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.82
|
| Rate for Payer: PHCS Commercial |
$11,596.88
|
| Rate for Payer: United Healthcare All Payer |
$10,630.47
|
|
|
REFL HA PER HOLE SZ 60E
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA PER HOLE SZ 60E
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL INTERFIT ACET SHELL NH 54
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 54
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 56
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 56
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 58
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 58
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 60
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 60
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 62
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 62
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
REFL INTERFIT ACET SHELL NH 64
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
