|
RF INTERFIT HA ACET NH SZ 68MM
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
RF INTERFIT HA ACET TH SZ 46MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 46MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 48MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 48MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 50MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 50MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 52MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 52MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 54MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 54MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 56MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 56MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 58MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 58MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 60MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 60MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 62MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 62MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 64MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 64MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 66MM
|
Facility
|
OP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem Medicaid |
$3,883.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Humana KY Medicaid |
$3,883.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,923.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,961.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT HA ACET TH SZ 66MM
|
Facility
|
IP
|
$11,292.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,387.75 |
| Max. Negotiated Rate |
$10,840.81 |
| Rate for Payer: Aetna Commercial |
$8,695.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,808.16
|
| Rate for Payer: Cash Price |
$5,646.26
|
| Rate for Payer: Cigna Commercial |
$9,372.78
|
| Rate for Payer: First Health Commercial |
$10,727.88
|
| Rate for Payer: Humana Commercial |
$9,598.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,259.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,333.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,387.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,937.41
|
| Rate for Payer: Ohio Health Group HMO |
$8,469.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,034.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,824.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,791.83
|
| Rate for Payer: PHCS Commercial |
$10,840.81
|
| Rate for Payer: United Healthcare All Payer |
$9,937.41
|
|
|
RF INTERFIT TPRD ID 46MM
|
Facility
|
IP
|
$11,376.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,413.02 |
| Max. Negotiated Rate |
$10,921.67 |
| Rate for Payer: Aetna Commercial |
$8,760.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,873.86
|
| Rate for Payer: Cash Price |
$5,688.37
|
| Rate for Payer: Cigna Commercial |
$9,442.69
|
| Rate for Payer: First Health Commercial |
$10,807.90
|
| Rate for Payer: Humana Commercial |
$9,670.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,328.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,396.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,413.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,011.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,532.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,101.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,897.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,849.95
|
| Rate for Payer: PHCS Commercial |
$10,921.67
|
| Rate for Payer: United Healthcare All Payer |
$10,011.53
|
|
|
RF INTERFIT TPRD ID 46MM
|
Facility
|
OP
|
$11,376.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,413.02 |
| Max. Negotiated Rate |
$10,921.67 |
| Rate for Payer: Aetna Commercial |
$8,760.09
|
| Rate for Payer: Anthem Medicaid |
$3,912.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,873.86
|
| Rate for Payer: Cash Price |
$5,688.37
|
| Rate for Payer: Cigna Commercial |
$9,442.69
|
| Rate for Payer: First Health Commercial |
$10,807.90
|
| Rate for Payer: Humana Commercial |
$9,670.23
|
| Rate for Payer: Humana KY Medicaid |
$3,912.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,952.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,328.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,396.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,413.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,011.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,532.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,101.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,897.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,849.95
|
| Rate for Payer: PHCS Commercial |
$10,921.67
|
| Rate for Payer: United Healthcare All Payer |
$10,011.53
|
|
