|
REFL INTRFIT ACET SHL 3H SZ 52
|
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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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
|
|
|
REFL INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 LNR 32ID 50-52OD 0 DEGSZE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 50-52OD 0 DEGSZE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 54-56OD 0 DEGSZF
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 54-56OD 0 DEGSZF
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 58-60OD 0 DEGSZG
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 58-60OD 0 DEGSZG
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 62-64OD 0 DEGSZH
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 62-64OD 0 DEGSZH
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 66-68OD 0 DEGSZJ
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REFL LNR 32ID 66-68OD 0 DEGSZJ
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
