|
RF ACET MH SZ 50E
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 50E
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 52E
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 52E
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 54F
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 54F
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 56F
|
Facility
|
OP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem Medicaid |
$4,455.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Humana KY Medicaid |
$4,455.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 56F
|
Facility
|
IP
|
$12,956.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.29 |
| Max. Negotiated Rate |
$12,437.84 |
| Rate for Payer: Aetna Commercial |
$9,976.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,105.74
|
| Rate for Payer: Cash Price |
$6,478.04
|
| Rate for Payer: Cigna Commercial |
$10,753.55
|
| Rate for Payer: First Health Commercial |
$12,308.28
|
| Rate for Payer: Humana Commercial |
$11,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,623.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,561.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,401.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,717.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,591.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,684.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,016.38
|
| Rate for Payer: PHCS Commercial |
$12,437.84
|
| Rate for Payer: United Healthcare All Payer |
$11,401.35
|
|
|
RF ACET MH SZ 58G
|
Facility
|
OP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem Medicaid |
$4,839.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Humana KY Medicaid |
$4,839.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,888.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,936.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 58G
|
Facility
|
IP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 60G
|
Facility
|
OP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem Medicaid |
$4,839.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Humana KY Medicaid |
$4,839.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,888.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,936.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 60G
|
Facility
|
IP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 62H
|
Facility
|
IP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 62H
|
Facility
|
OP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem Medicaid |
$4,839.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Humana KY Medicaid |
$4,839.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,888.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,936.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 64H
|
Facility
|
IP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 64H
|
Facility
|
OP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem Medicaid |
$4,839.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Humana KY Medicaid |
$4,839.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,888.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,936.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 66J
|
Facility
|
OP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem Medicaid |
$4,839.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Humana KY Medicaid |
$4,839.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,888.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,936.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 66J
|
Facility
|
IP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 68J
|
Facility
|
IP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RF ACET MH SZ 68J
|
Facility
|
OP
|
$14,071.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.25 |
| Max. Negotiated Rate |
$13,508.30 |
| Rate for Payer: Aetna Commercial |
$10,834.79
|
| Rate for Payer: Anthem Medicaid |
$4,839.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,975.50
|
| Rate for Payer: Cash Price |
$7,035.58
|
| Rate for Payer: Cigna Commercial |
$11,679.05
|
| Rate for Payer: First Health Commercial |
$13,367.59
|
| Rate for Payer: Humana Commercial |
$11,960.48
|
| Rate for Payer: Humana KY Medicaid |
$4,839.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,888.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,538.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,384.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,221.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,936.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,382.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,553.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,814.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,829.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.06
|
| Rate for Payer: PHCS Commercial |
$13,508.30
|
| Rate for Payer: United Healthcare All Payer |
$12,382.61
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
45000298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
45000298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem Medicaid |
$194.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Humana KY Medicaid |
$194.65
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$196.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
76102574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
76102574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
RFB EMBEDDED EYELID
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
76102398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
