|
REFL LNR 32ID 66-68OD 0 DEGSZJ
|
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 66-68OD 0 DEGSZJ
|
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 70-76OD 0 DEGSZK
|
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 70-76OD 0 DEGSZK
|
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 MULTI HOLE PC W/LOCK 50
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 50
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 52
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 52
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 54
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 54
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 56
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 56
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 58
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 58
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 60
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 60
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 62
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 62
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 64
|
Facility
|
OP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem Medicaid |
$3,467.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Humana KY Medicaid |
$3,467.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REFL MULTI HOLE PC W/LOCK 64
|
Facility
|
IP
|
$10,081.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.57 |
| Max. Negotiated Rate |
$9,678.63 |
| Rate for Payer: Aetna Commercial |
$7,763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.89
|
| Rate for Payer: Cash Price |
$5,040.96
|
| Rate for Payer: Cigna Commercial |
$8,367.99
|
| Rate for Payer: First Health Commercial |
$9,577.81
|
| Rate for Payer: Humana Commercial |
$8,569.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,872.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,065.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,771.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,956.52
|
| Rate for Payer: PHCS Commercial |
$9,678.63
|
| Rate for Payer: United Healthcare All Payer |
$8,872.08
|
|
|
REF LNR 22*42 20 DEG SZ B
|
Facility
|
OP
|
$5,286.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.89 |
| Max. Negotiated Rate |
$5,074.86 |
| Rate for Payer: Aetna Commercial |
$4,070.46
|
| Rate for Payer: Anthem Medicaid |
$1,817.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,123.32
|
| Rate for Payer: Cash Price |
$2,643.16
|
| Rate for Payer: Cigna Commercial |
$4,387.64
|
| Rate for Payer: First Health Commercial |
$5,021.99
|
| Rate for Payer: Humana Commercial |
$4,493.36
|
| Rate for Payer: Humana KY Medicaid |
$1,817.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,836.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,334.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,901.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,854.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,651.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,964.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,229.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,599.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,647.55
|
| Rate for Payer: PHCS Commercial |
$5,074.86
|
| Rate for Payer: United Healthcare All Payer |
$4,651.95
|
|
|
REF LNR 22*42 20 DEG SZ B
|
Facility
|
IP
|
$5,286.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,585.89 |
| Max. Negotiated Rate |
$5,074.86 |
| Rate for Payer: Aetna Commercial |
$4,070.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,123.32
|
| Rate for Payer: Cash Price |
$2,643.16
|
| Rate for Payer: Cigna Commercial |
$4,387.64
|
| Rate for Payer: First Health Commercial |
$5,021.99
|
| Rate for Payer: Humana Commercial |
$4,493.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,334.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,901.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,585.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,651.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,964.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,229.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,599.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,647.55
|
| Rate for Payer: PHCS Commercial |
$5,074.86
|
| Rate for Payer: United Healthcare All Payer |
$4,651.95
|
|
|
REF LNR 22*44 20 DEG SZ C
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 22*44 20 DEG SZ C
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 22*46-48 20 DEG SZ D
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
