|
REFL INTERFIT ACET SHELL NH 64
|
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 66
|
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 66
|
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 68
|
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 68
|
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 INTFT ACETSHL MULTIHOL 52
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 52
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 54
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 54
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 56
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 56
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 58
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 58
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 60
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 60
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 62
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 62
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 64
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 64
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 66
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 66
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 68
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 68
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 70
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
REFL INTFT ACETSHL MULTIHOL 70
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
