|
REF SP3 3H SHELL 68MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF THREADED HOLE COVER
|
Facility
|
OP
|
$1,553.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.09 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$1,196.30
|
| Rate for Payer: Anthem Medicaid |
$534.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,211.83
|
| Rate for Payer: Cash Price |
$776.81
|
| Rate for Payer: Cigna Commercial |
$1,289.51
|
| Rate for Payer: First Health Commercial |
$1,475.95
|
| Rate for Payer: Humana Commercial |
$1,320.59
|
| Rate for Payer: Humana KY Medicaid |
$534.29
|
| Rate for Payer: Kentucky WC Medicaid |
$539.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,273.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,242.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.00
|
| Rate for Payer: PHCS Commercial |
$1,491.48
|
| Rate for Payer: United Healthcare All Payer |
$1,367.19
|
|
|
REF THREADED HOLE COVER
|
Facility
|
IP
|
$1,553.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.09 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$1,196.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,211.83
|
| Rate for Payer: Cash Price |
$776.81
|
| Rate for Payer: Cigna Commercial |
$1,289.51
|
| Rate for Payer: First Health Commercial |
$1,475.95
|
| Rate for Payer: Humana Commercial |
$1,320.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,273.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,146.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,242.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,351.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,072.00
|
| Rate for Payer: PHCS Commercial |
$1,491.48
|
| Rate for Payer: United Healthcare All Payer |
$1,367.19
|
|
|
REF V POR ACET SHELL 44OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 44OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 46OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 46OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 48OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 48OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 50OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 50OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 52OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 52OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 54OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 54OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 56OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 56OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 58OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 58OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 60OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 60OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 62OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 62OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 64OD
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
REF V POR ACET SHELL 64OD
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
