|
RF I POR CTD HA ACET SHEL SZ68
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR CTD HA ACET SHEL SZ70
|
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 I POR CTD HA ACET SHEL SZ70
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 42MM
|
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 I POR HA ACET SHELL 42MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 44MM
|
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 I POR HA ACET SHELL 44MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 46MM
|
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 I POR HA ACET SHELL 46MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 48MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 48MM
|
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 I POR HA ACET SHELL 50MM
|
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 I POR HA ACET SHELL 50MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 52MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 52MM
|
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 I POR HA ACET SHELL 54MM
|
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 I POR HA ACET SHELL 54MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 56MM
|
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 I POR HA ACET SHELL 56MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 58MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 58MM
|
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 I POR HA ACET SHELL 60MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 60MM
|
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 I POR HA ACET SHELL 62MM
|
Facility
|
OP
|
$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 Medicaid |
$3,924.26
|
| 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: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| 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: Molina Healthcare Medicaid |
$4,003.00
|
| 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 I POR HA ACET SHELL 62MM
|
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
|
|
