|
REF I POR ACET SHELL 58OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 60OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 60OD
|
Facility
|
IP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 62OD
|
Facility
|
IP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 62OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 64OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 64OD
|
Facility
|
IP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 66OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 66OD
|
Facility
|
IP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 68OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 68OD
|
Facility
|
IP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 70OD
|
Facility
|
IP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REF I POR ACET SHELL 70OD
|
Facility
|
OP
|
$11,694.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,508.48 |
| Max. Negotiated Rate |
$11,227.13 |
| Rate for Payer: Aetna Commercial |
$9,005.10
|
| Rate for Payer: Anthem Medicaid |
$4,021.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.05
|
| Rate for Payer: Cash Price |
$5,847.46
|
| Rate for Payer: Cigna Commercial |
$9,706.79
|
| Rate for Payer: First Health Commercial |
$11,110.18
|
| Rate for Payer: Humana Commercial |
$9,940.69
|
| Rate for Payer: Humana KY Medicaid |
$4,021.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,355.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,174.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,069.50
|
| Rate for Payer: PHCS Commercial |
$11,227.13
|
| Rate for Payer: United Healthcare All Payer |
$10,291.54
|
|
|
REFL 3 HOLE SCRATCH MM 50
|
Facility
|
IP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 50
|
Facility
|
OP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem Medicaid |
$3,751.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Humana KY Medicaid |
$3,751.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 52
|
Facility
|
IP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 52
|
Facility
|
OP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem Medicaid |
$3,751.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Humana KY Medicaid |
$3,751.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 56
|
Facility
|
OP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem Medicaid |
$3,751.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Humana KY Medicaid |
$3,751.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 56
|
Facility
|
IP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 58
|
Facility
|
OP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem Medicaid |
$3,751.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Humana KY Medicaid |
$3,751.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 58
|
Facility
|
IP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 60
|
Facility
|
IP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REFL 3 HOLE SCRATCH MM 60
|
Facility
|
OP
|
$10,908.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.64 |
| Max. Negotiated Rate |
$10,472.46 |
| Rate for Payer: Aetna Commercial |
$8,399.78
|
| Rate for Payer: Anthem Medicaid |
$3,751.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.87
|
| Rate for Payer: Cash Price |
$5,454.41
|
| Rate for Payer: Cigna Commercial |
$9,054.31
|
| Rate for Payer: First Health Commercial |
$10,363.37
|
| Rate for Payer: Humana Commercial |
$9,272.49
|
| Rate for Payer: Humana KY Medicaid |
$3,751.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,945.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,599.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,181.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,727.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,490.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.08
|
| Rate for Payer: PHCS Commercial |
$10,472.46
|
| Rate for Payer: United Healthcare All Payer |
$9,599.75
|
|
|
REF LAB MISC SERVICE
|
Facility
|
IP
|
$340.00
|
|
| Hospital Charge Code |
30001565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.02
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
REF LAB MISC SERVICE
|
Facility
|
OP
|
$340.00
|
|
| Hospital Charge Code |
30001565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem Medicaid |
$116.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.02
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Humana KY Medicaid |
$116.93
|
| Rate for Payer: Kentucky WC Medicaid |
$118.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
