|
RF I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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
|
|
|
RF I POR HA ACET SHELL 54MM
|
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 56MM
|
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 56MM
|
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 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 I POR HA ACET SHELL 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 LNR 28*46-48 0 DEG L +4
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
RF LNR 28*46-48 0 DEG L +4
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
RF LNR 28*46-48 20 DEG L +4
|
Facility
|
IP
|
$6,467.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.73 |
| Max. Negotiated Rate |
$6,208.47 |
| Rate for Payer: Aetna Commercial |
$4,979.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.38
|
| Rate for Payer: Cash Price |
$3,233.58
|
| Rate for Payer: Cigna Commercial |
$5,367.74
|
| Rate for Payer: First Health Commercial |
$6,143.80
|
| Rate for Payer: Humana Commercial |
$5,497.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.82
|
| Rate for Payer: PHCS Commercial |
$6,208.47
|
| Rate for Payer: United Healthcare All Payer |
$5,691.10
|
|
|
RF LNR 28*46-48 20 DEG L +4
|
Facility
|
OP
|
$6,467.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.73 |
| Max. Negotiated Rate |
$6,208.47 |
| Rate for Payer: Aetna Commercial |
$4,979.71
|
| Rate for Payer: Anthem Medicaid |
$2,224.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.38
|
| Rate for Payer: Cash Price |
$3,233.58
|
| Rate for Payer: Cigna Commercial |
$5,367.74
|
| Rate for Payer: First Health Commercial |
$6,143.80
|
| Rate for Payer: Humana Commercial |
$5,497.09
|
| Rate for Payer: Humana KY Medicaid |
$2,224.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.82
|
| Rate for Payer: PHCS Commercial |
$6,208.47
|
| Rate for Payer: United Healthcare All Payer |
$5,691.10
|
|
|
RF LNR 28*50-52 0 DEG L +4
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
RF LNR 28*50-52 0 DEG L +4
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
RF LNR 28*50-52 20 DEG L +4
|
Facility
|
IP
|
$6,467.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.73 |
| Max. Negotiated Rate |
$6,208.47 |
| Rate for Payer: Aetna Commercial |
$4,979.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.38
|
| Rate for Payer: Cash Price |
$3,233.58
|
| Rate for Payer: Cigna Commercial |
$5,367.74
|
| Rate for Payer: First Health Commercial |
$6,143.80
|
| Rate for Payer: Humana Commercial |
$5,497.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.82
|
| Rate for Payer: PHCS Commercial |
$6,208.47
|
| Rate for Payer: United Healthcare All Payer |
$5,691.10
|
|
|
RF LNR 28*50-52 20 DEG L +4
|
Facility
|
OP
|
$6,467.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.73 |
| Max. Negotiated Rate |
$6,208.47 |
| Rate for Payer: Aetna Commercial |
$4,979.71
|
| Rate for Payer: Anthem Medicaid |
$2,224.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.38
|
| Rate for Payer: Cash Price |
$3,233.58
|
| Rate for Payer: Cigna Commercial |
$5,367.74
|
| Rate for Payer: First Health Commercial |
$6,143.80
|
| Rate for Payer: Humana Commercial |
$5,497.09
|
| Rate for Payer: Humana KY Medicaid |
$2,224.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.82
|
| Rate for Payer: PHCS Commercial |
$6,208.47
|
| Rate for Payer: United Healthcare All Payer |
$5,691.10
|
|
|
RF LNR 28*54-56 0 DEG L +4
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
RF LNR 28*54-56 0 DEG L +4
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
RF LNR 28*54-56 20 DEG L +4
|
Facility
|
IP
|
$6,467.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.73 |
| Max. Negotiated Rate |
$6,208.47 |
| Rate for Payer: Aetna Commercial |
$4,979.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.38
|
| Rate for Payer: Cash Price |
$3,233.58
|
| Rate for Payer: Cigna Commercial |
$5,367.74
|
| Rate for Payer: First Health Commercial |
$6,143.80
|
| Rate for Payer: Humana Commercial |
$5,497.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,772.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.82
|
| Rate for Payer: PHCS Commercial |
$6,208.47
|
| Rate for Payer: United Healthcare All Payer |
$5,691.10
|
|
