|
REFL INTRFIT ACET SHL 3H SZ 50
|
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 52
|
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 52
|
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 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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 INTRFIT ACET SHL 3H SZ 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
|
|
|
REFL INTRFIT ACET SHL 3H SZ 62
|
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 64
|
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 64
|
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 66
|
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 66
|
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 68
|
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 68
|
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 LNR 32ID 50-52OD 0 DEGSZE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 50-52OD 0 DEGSZE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 54-56OD 0 DEGSZF
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 54-56OD 0 DEGSZF
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 58-60OD 0 DEGSZG
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 58-60OD 0 DEGSZG
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 62-64OD 0 DEGSZH
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REFL LNR 32ID 62-64OD 0 DEGSZH
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
