|
RF LNR 28*46-48 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*46-48 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*46-48 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*46-48 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*50-52 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*50-52 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*50-52 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*50-52 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*54-56 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*54-56 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*54-56 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*54-56 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*58-60 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*58-60 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*58-60 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*58-60 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*62-64 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*62-64 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*62-64 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*62-64 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*66-68 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*66-68 0 DEG L +4
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
RF LNR 28*66-68 20 DEG L +4
|
Facility
|
IP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*66-68 20 DEG L +4
|
Facility
|
OP
|
$6,667.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.15 |
| Max. Negotiated Rate |
$6,400.47 |
| Rate for Payer: Aetna Commercial |
$5,133.71
|
| Rate for Payer: Anthem Medicaid |
$2,292.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.38
|
| Rate for Payer: Cash Price |
$3,333.58
|
| Rate for Payer: Cigna Commercial |
$5,533.74
|
| Rate for Payer: First Health Commercial |
$6,333.80
|
| Rate for Payer: Humana Commercial |
$5,667.09
|
| Rate for Payer: Humana KY Medicaid |
$2,292.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,333.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.34
|
| Rate for Payer: PHCS Commercial |
$6,400.47
|
| Rate for Payer: United Healthcare All Payer |
$5,867.10
|
|
|
RF LNR 28*70-76 0 DEG L +4
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
