|
REFL HA MH SHELL 62MM H
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 62MM H
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 64MM H
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 64MM H
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 66MM J
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 66MM J
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 68MM J
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 68MM J
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA PER HOLE SZ 54D
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA PER HOLE SZ 54D
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA PER HOLE SZ 56D
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA PER HOLE SZ 56D
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA PER HOLE SZ 58E
|
Facility
|
IP
|
$12,328.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,698.45 |
| Max. Negotiated Rate |
$11,835.05 |
| Rate for Payer: Aetna Commercial |
$9,492.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,615.98
|
| Rate for Payer: Cash Price |
$6,164.09
|
| Rate for Payer: Cigna Commercial |
$10,232.39
|
| Rate for Payer: First Health Commercial |
$11,711.77
|
| Rate for Payer: Humana Commercial |
$10,478.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,109.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,098.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,698.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,848.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,862.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,725.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,506.44
|
| Rate for Payer: PHCS Commercial |
$11,835.05
|
| Rate for Payer: United Healthcare All Payer |
$10,848.80
|
|
|
REFL HA PER HOLE SZ 58E
|
Facility
|
OP
|
$12,328.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,698.45 |
| Max. Negotiated Rate |
$11,835.05 |
| Rate for Payer: Aetna Commercial |
$9,492.70
|
| Rate for Payer: Anthem Medicaid |
$4,239.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,615.98
|
| Rate for Payer: Cash Price |
$6,164.09
|
| Rate for Payer: Cigna Commercial |
$10,232.39
|
| Rate for Payer: First Health Commercial |
$11,711.77
|
| Rate for Payer: Humana Commercial |
$10,478.95
|
| Rate for Payer: Humana KY Medicaid |
$4,239.66
|
| Rate for Payer: Kentucky WC Medicaid |
$4,282.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,109.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,098.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,698.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,324.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,848.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,862.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,725.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,506.44
|
| Rate for Payer: PHCS Commercial |
$11,835.05
|
| Rate for Payer: United Healthcare All Payer |
$10,848.80
|
|
|
REFL HA PER HOLE SZ 60E
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA PER HOLE SZ 60E
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL INTERFIT ACET SHELL NH 54
|
Facility
|
IP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 54
|
Facility
|
OP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem Medicaid |
$4,329.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Humana KY Medicaid |
$4,329.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 56
|
Facility
|
IP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 56
|
Facility
|
OP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem Medicaid |
$4,329.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Humana KY Medicaid |
$4,329.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 58
|
Facility
|
IP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 58
|
Facility
|
OP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem Medicaid |
$4,329.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Humana KY Medicaid |
$4,329.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 60
|
Facility
|
OP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem Medicaid |
$4,329.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Humana KY Medicaid |
$4,329.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,373.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,416.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 60
|
Facility
|
IP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
|
REFL INTERFIT ACET SHELL NH 62
|
Facility
|
IP
|
$12,588.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,776.62 |
| Max. Negotiated Rate |
$12,085.20 |
| Rate for Payer: Aetna Commercial |
$9,693.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,819.23
|
| Rate for Payer: Cash Price |
$6,294.38
|
| Rate for Payer: Cigna Commercial |
$10,448.66
|
| Rate for Payer: First Health Commercial |
$11,959.31
|
| Rate for Payer: Humana Commercial |
$10,700.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,322.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,290.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,776.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,078.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,441.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,071.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,952.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,686.24
|
| Rate for Payer: PHCS Commercial |
$12,085.20
|
| Rate for Payer: United Healthcare All Payer |
$11,078.10
|
|
