|
ACET LNR 22*63-70 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 22*63-70 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*46-48 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*46-48 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*46-48 20 DEG
|
Facility
|
OP
|
$11,233.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,460.30 |
| Max. Negotiated Rate |
$10,783.77 |
| Rate for Payer: Aetna Commercial |
$8,649.48
|
| Rate for Payer: Anthem Medicaid |
$3,863.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,761.81
|
| Rate for Payer: Cash Price |
$5,616.55
|
| Rate for Payer: Cigna Commercial |
$9,323.46
|
| Rate for Payer: First Health Commercial |
$10,671.44
|
| Rate for Payer: Humana Commercial |
$9,548.13
|
| Rate for Payer: Humana KY Medicaid |
$3,863.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,902.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,211.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,290.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,369.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,940.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,885.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,424.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,246.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,460.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,482.26
|
| Rate for Payer: PHCS Commercial |
$10,783.77
|
| Rate for Payer: United Healthcare All Payer |
$9,885.12
|
|
|
ACET LNR 26*46-48 20 DEG
|
Facility
|
IP
|
$11,233.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,460.30 |
| Max. Negotiated Rate |
$10,783.77 |
| Rate for Payer: Aetna Commercial |
$8,649.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,761.81
|
| Rate for Payer: Cash Price |
$5,616.55
|
| Rate for Payer: Cigna Commercial |
$9,323.46
|
| Rate for Payer: First Health Commercial |
$10,671.44
|
| Rate for Payer: Humana Commercial |
$9,548.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,211.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,290.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,369.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,885.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,424.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,246.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,460.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,482.26
|
| Rate for Payer: PHCS Commercial |
$10,783.77
|
| Rate for Payer: United Healthcare All Payer |
$9,885.12
|
|
|
ACET LNR 26*50-54 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*50-54 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*50-54 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*50-54 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*56-62 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*56-62 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*56-62 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*56-62 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*63-70 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*63-70 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*63-70 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 26*63-70 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*50-54 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*50-54 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*50-54 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*50-54 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*56-62 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*56-62 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*56-62 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
