|
RF LNR 28*54-56 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*58-60 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*58-60 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*58-60 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*58-60 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*62-64 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*62-64 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*62-64 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*62-64 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*66-68 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*66-68 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*66-68 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*66-68 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*70-76 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*70-76 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*70-76 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*70-76 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
|
|
|
RH IG FULL-DOSE IM
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
77000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.57 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$564.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Healthspan PPO |
$123.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$155.38
|
| Rate for Payer: Multiplan PHCS |
$338.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$394.80
|
| Rate for Payer: UHCCP Medicaid |
$197.40
|
|
|
RH IG FULL-DOSE IM
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
77000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$193.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$193.96
|
| Rate for Payer: Kentucky WC Medicaid |
$195.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.84
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RH IG FULL-DOSE IM
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
77000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.84
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RH IG FULL-DOSE IM(T
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
770T0006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.84
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RH IG FULL-DOSE IM(T
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
HCPCS 90384
|
| Hospital Charge Code |
770T0006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$541.44 |
| Rate for Payer: Aetna Commercial |
$434.28
|
| Rate for Payer: Anthem Medicaid |
$193.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$439.92
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$468.12
|
| Rate for Payer: First Health Commercial |
$535.80
|
| Rate for Payer: Humana Commercial |
$479.40
|
| Rate for Payer: Humana KY Medicaid |
$193.96
|
| Rate for Payer: Kentucky WC Medicaid |
$195.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$462.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$496.32
|
| Rate for Payer: Ohio Health Group HMO |
$423.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.84
|
| Rate for Payer: PHCS Commercial |
$541.44
|
| Rate for Payer: United Healthcare All Payer |
$496.32
|
|
|
RHINOPLASTY
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
76101129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.86 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,258.84
|
| Rate for Payer: Anthem Medicaid |
$376.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,340.27
|
| Rate for Payer: Healthspan PPO |
$1,061.60
|
| Rate for Payer: Humana Medicaid |
$376.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,144.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.40
|
| Rate for Payer: Molina Healthcare Passport |
$376.86
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$380.63
|
|
|
RHINOPLASTY
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
76101130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
RHINOPLASTY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
76101129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
