|
RF INTERFIT TPRD ID 58MM
|
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 60MM
|
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 60MM
|
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 62MM
|
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 62MM
|
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 64MM
|
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 64MM
|
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 66MM
|
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 66MM
|
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 I POR CTD HA ACET SHEL SZ64
|
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 I POR CTD HA ACET SHEL SZ64
|
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 I POR CTD HA ACET SHEL SZ66
|
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 I POR CTD HA ACET SHEL SZ66
|
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 I POR CTD HA ACET SHEL SZ68
|
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 I POR CTD HA ACET SHEL SZ68
|
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 I POR CTD HA ACET SHEL SZ70
|
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 I POR CTD HA ACET SHEL SZ70
|
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 I POR HA ACET SHELL 42MM
|
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 I POR HA ACET SHELL 42MM
|
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 I POR HA ACET SHELL 44MM
|
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 I POR HA ACET SHELL 44MM
|
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 I POR HA ACET SHELL 46MM
|
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 I POR HA ACET SHELL 46MM
|
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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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
|
|
