|
REFL INTFT ACETSHL MULTIHOL 70
|
Facility
|
OP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem Medicaid |
$4,542.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Humana KY Medicaid |
$4,542.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,588.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,633.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 70
|
Facility
|
IP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 72
|
Facility
|
OP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem Medicaid |
$4,542.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Humana KY Medicaid |
$4,542.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,588.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,633.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 72
|
Facility
|
IP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 74
|
Facility
|
OP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem Medicaid |
$4,542.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Humana KY Medicaid |
$4,542.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,588.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,633.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 74
|
Facility
|
IP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 76
|
Facility
|
IP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTFT ACETSHL MULTIHOL 76
|
Facility
|
OP
|
$13,208.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,962.70 |
| Max. Negotiated Rate |
$12,680.63 |
| Rate for Payer: Aetna Commercial |
$10,170.92
|
| Rate for Payer: Anthem Medicaid |
$4,542.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,303.01
|
| Rate for Payer: Cash Price |
$6,604.49
|
| Rate for Payer: Cigna Commercial |
$10,963.46
|
| Rate for Payer: First Health Commercial |
$12,548.54
|
| Rate for Payer: Humana Commercial |
$11,227.64
|
| Rate for Payer: Humana KY Medicaid |
$4,542.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,588.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,831.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,748.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,962.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,633.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,623.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,906.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,567.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,491.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,114.20
|
| Rate for Payer: PHCS Commercial |
$12,680.63
|
| Rate for Payer: United Healthcare All Payer |
$11,623.91
|
|
|
REFL INTRFIT ACET SHEL NH 42MM
|
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 INTRFIT ACET SHEL NH 42MM
|
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 INTRFIT ACET SHEL NH 44MM
|
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 INTRFIT ACET SHEL NH 44MM
|
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 INTRFIT ACET SHEL NH 46MM
|
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 INTRFIT ACET SHEL NH 46MM
|
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 INTRFIT ACET SHEL NH 48MM
|
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 INTRFIT ACET SHEL NH 48MM
|
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 INTRFIT ACET SHL 3H SZ 42
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL INTRFIT ACET SHL 3H SZ 42
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL INTRFIT ACET SHL 3H SZ 44
|
Facility
|
IP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL INTRFIT ACET SHL 3H SZ 44
|
Facility
|
OP
|
$12,496.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.99 |
| Max. Negotiated Rate |
$11,996.77 |
| Rate for Payer: Aetna Commercial |
$9,622.41
|
| Rate for Payer: Anthem Medicaid |
$4,297.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,747.38
|
| Rate for Payer: Cash Price |
$6,248.32
|
| Rate for Payer: Cigna Commercial |
$10,372.21
|
| Rate for Payer: First Health Commercial |
$11,871.81
|
| Rate for Payer: Humana Commercial |
$10,622.14
|
| Rate for Payer: Humana KY Medicaid |
$4,297.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,247.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,222.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,748.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,383.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,997.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,372.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,997.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,872.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,622.68
|
| Rate for Payer: PHCS Commercial |
$11,996.77
|
| Rate for Payer: United Healthcare All Payer |
$10,997.04
|
|
|
REFL INTRFIT ACET SHL 3H SZ 46
|
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 INTRFIT ACET SHL 3H SZ 46
|
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 INTRFIT ACET SHL 3H SZ 48
|
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 INTRFIT ACET SHL 3H SZ 48
|
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 INTRFIT ACET SHL 3H SZ 50
|
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
|
|
