|
RF FSO 5 POR HA ACET 58MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 58MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 60MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 60MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 62MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 62MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 68MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF FSO 5 POR HA ACET 68MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT ACET NH SZ 50
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
RF INTERFIT ACET NH SZ 50
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
RF INTERFIT ACET NH SZ 52
|
Facility
|
IP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
RF INTERFIT ACET NH SZ 52
|
Facility
|
OP
|
$12,339.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.10 |
| Max. Negotiated Rate |
$11,845.66 |
| Rate for Payer: Aetna Commercial |
$9,501.21
|
| Rate for Payer: Anthem Medicaid |
$4,243.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,624.60
|
| Rate for Payer: Cash Price |
$6,169.61
|
| Rate for Payer: Cigna Commercial |
$10,241.56
|
| Rate for Payer: First Health Commercial |
$11,722.27
|
| Rate for Payer: Humana Commercial |
$10,488.35
|
| Rate for Payer: Humana KY Medicaid |
$4,243.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,118.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,106.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,328.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,858.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,254.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,825.16
|
| Rate for Payer: PHCS Commercial |
$11,845.66
|
| Rate for Payer: United Healthcare All Payer |
$10,858.52
|
|
|
RF INTERFIT HA ACET NH SZ 42MM
|
Facility
|
OP
|
$11,050.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.51 |
| Max. Negotiated Rate |
$10,608.04 |
| Rate for Payer: Aetna Commercial |
$8,508.53
|
| Rate for Payer: Anthem Medicaid |
$3,800.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,619.03
|
| Rate for Payer: Cash Price |
$5,525.02
|
| Rate for Payer: Cigna Commercial |
$9,171.53
|
| Rate for Payer: First Health Commercial |
$10,497.54
|
| Rate for Payer: Humana Commercial |
$9,392.53
|
| Rate for Payer: Humana KY Medicaid |
$3,800.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,838.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,061.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,154.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,315.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,876.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,724.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,287.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,210.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,436.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,425.51
|
| Rate for Payer: PHCS Commercial |
$10,608.04
|
| Rate for Payer: United Healthcare All Payer |
$9,724.04
|
|
|
RF INTERFIT HA ACET NH SZ 42MM
|
Facility
|
IP
|
$11,050.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.51 |
| Max. Negotiated Rate |
$10,608.04 |
| Rate for Payer: Aetna Commercial |
$8,508.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,619.03
|
| Rate for Payer: Cash Price |
$5,525.02
|
| Rate for Payer: Cigna Commercial |
$9,171.53
|
| Rate for Payer: First Health Commercial |
$10,497.54
|
| Rate for Payer: Humana Commercial |
$9,392.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,061.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,154.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,315.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,724.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,287.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,210.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,436.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,425.51
|
| Rate for Payer: PHCS Commercial |
$10,608.04
|
| Rate for Payer: United Healthcare All Payer |
$9,724.04
|
|
|
RF INTERFIT HA ACET NH SZ 44MM
|
Facility
|
IP
|
$11,050.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.51 |
| Max. Negotiated Rate |
$10,608.04 |
| Rate for Payer: Aetna Commercial |
$8,508.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,619.03
|
| Rate for Payer: Cash Price |
$5,525.02
|
| Rate for Payer: Cigna Commercial |
$9,171.53
|
| Rate for Payer: First Health Commercial |
$10,497.54
|
| Rate for Payer: Humana Commercial |
$9,392.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,061.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,154.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,315.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,724.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,287.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,210.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,436.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,425.51
|
| Rate for Payer: PHCS Commercial |
$10,608.04
|
| Rate for Payer: United Healthcare All Payer |
$9,724.04
|
|
|
RF INTERFIT HA ACET NH SZ 44MM
|
Facility
|
OP
|
$11,050.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.51 |
| Max. Negotiated Rate |
$10,608.04 |
| Rate for Payer: Aetna Commercial |
$8,508.53
|
| Rate for Payer: Anthem Medicaid |
$3,800.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,619.03
|
| Rate for Payer: Cash Price |
$5,525.02
|
| Rate for Payer: Cigna Commercial |
$9,171.53
|
| Rate for Payer: First Health Commercial |
$10,497.54
|
| Rate for Payer: Humana Commercial |
$9,392.53
|
| Rate for Payer: Humana KY Medicaid |
$3,800.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,838.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,061.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,154.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,315.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,876.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,724.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,287.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,210.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,436.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,425.51
|
| Rate for Payer: PHCS Commercial |
$10,608.04
|
| Rate for Payer: United Healthcare All Payer |
$9,724.04
|
|
|
RF INTERFIT HA ACET NH SZ 46MM
|
Facility
|
IP
|
$11,050.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.51 |
| Max. Negotiated Rate |
$10,608.04 |
| Rate for Payer: Aetna Commercial |
$8,508.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,619.03
|
| Rate for Payer: Cash Price |
$5,525.02
|
| Rate for Payer: Cigna Commercial |
$9,171.53
|
| Rate for Payer: First Health Commercial |
$10,497.54
|
| Rate for Payer: Humana Commercial |
$9,392.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,061.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,154.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,315.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,724.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,287.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,210.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,436.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,425.51
|
| Rate for Payer: PHCS Commercial |
$10,608.04
|
| Rate for Payer: United Healthcare All Payer |
$9,724.04
|
|
|
RF INTERFIT HA ACET NH SZ 46MM
|
Facility
|
OP
|
$11,050.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.51 |
| Max. Negotiated Rate |
$10,608.04 |
| Rate for Payer: Aetna Commercial |
$8,508.53
|
| Rate for Payer: Anthem Medicaid |
$3,800.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,619.03
|
| Rate for Payer: Cash Price |
$5,525.02
|
| Rate for Payer: Cigna Commercial |
$9,171.53
|
| Rate for Payer: First Health Commercial |
$10,497.54
|
| Rate for Payer: Humana Commercial |
$9,392.53
|
| Rate for Payer: Humana KY Medicaid |
$3,800.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,838.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,061.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,154.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,315.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,876.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,724.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,287.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,210.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,436.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,425.51
|
| Rate for Payer: PHCS Commercial |
$10,608.04
|
| Rate for Payer: United Healthcare All Payer |
$9,724.04
|
|
|
RF INTERFIT HA ACET NH SZ 48MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT HA ACET NH SZ 48MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT HA ACET NH SZ 50MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT HA ACET NH SZ 50MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT HA ACET NH SZ 52MM
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT HA ACET NH SZ 52MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
RF INTERFIT HA ACET NH SZ 54MM
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
