|
RF INTERFIT HA ACET TH SZ 56MM
|
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 TH SZ 56MM
|
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 TH SZ 58MM
|
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 TH SZ 58MM
|
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 TH SZ 60MM
|
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 TH SZ 60MM
|
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 TH SZ 62MM
|
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 TH SZ 62MM
|
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 TH SZ 64MM
|
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 TH SZ 64MM
|
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 TH SZ 66MM
|
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 TH SZ 66MM
|
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 TPRD ID 46MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 46MM
|
Facility
|
IP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 48MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 48MM
|
Facility
|
IP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 50MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 50MM
|
Facility
|
IP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 52MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 52MM
|
Facility
|
IP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 54MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 54MM
|
Facility
|
IP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 56MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 56MM
|
Facility
|
IP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
|
RF INTERFIT TPRD ID 58MM
|
Facility
|
OP
|
$11,133.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.40 |
| Max. Negotiated Rate |
$10,688.46 |
| Rate for Payer: Aetna Commercial |
$8,573.03
|
| Rate for Payer: Anthem Medicaid |
$3,828.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.37
|
| Rate for Payer: Cash Price |
$5,566.91
|
| Rate for Payer: Cigna Commercial |
$9,241.06
|
| Rate for Payer: First Health Commercial |
$10,577.12
|
| Rate for Payer: Humana Commercial |
$9,463.74
|
| Rate for Payer: Humana KY Medicaid |
$3,828.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,226.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,447.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,451.48
|
| Rate for Payer: PHCS Commercial |
$10,688.46
|
| Rate for Payer: United Healthcare All Payer |
$9,797.75
|
|
