|
ACET LNR 22*56-62 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*56-62 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*63-70 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*63-70 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*63-70 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 22*63-70 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*46-48 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*46-48 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*46-48 20 DEG
|
Facility
|
OP
|
$11,476.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.97 |
| Max. Negotiated Rate |
$11,017.50 |
| Rate for Payer: Aetna Commercial |
$8,836.95
|
| Rate for Payer: Anthem Medicaid |
$3,946.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,951.72
|
| Rate for Payer: Cash Price |
$5,738.28
|
| Rate for Payer: Cigna Commercial |
$9,525.54
|
| Rate for Payer: First Health Commercial |
$10,902.73
|
| Rate for Payer: Humana Commercial |
$9,755.08
|
| Rate for Payer: Humana KY Medicaid |
$3,946.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,986.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,410.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,469.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,442.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,025.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,099.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,607.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,181.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,984.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,918.83
|
| Rate for Payer: PHCS Commercial |
$11,017.50
|
| Rate for Payer: United Healthcare All Payer |
$10,099.37
|
|
|
ACET LNR 26*46-48 20 DEG
|
Facility
|
IP
|
$11,476.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.97 |
| Max. Negotiated Rate |
$11,017.50 |
| Rate for Payer: Aetna Commercial |
$8,836.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,951.72
|
| Rate for Payer: Cash Price |
$5,738.28
|
| Rate for Payer: Cigna Commercial |
$9,525.54
|
| Rate for Payer: First Health Commercial |
$10,902.73
|
| Rate for Payer: Humana Commercial |
$9,755.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,410.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,469.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,442.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,099.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,607.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,181.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,984.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,918.83
|
| Rate for Payer: PHCS Commercial |
$11,017.50
|
| Rate for Payer: United Healthcare All Payer |
$10,099.37
|
|
|
ACET LNR 26*50-54 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*50-54 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*50-54 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*50-54 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*56-62 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*56-62 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*56-62 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*56-62 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*63-70 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*63-70 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*63-70 20 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 26*63-70 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 28*50-54 0 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 28*50-54 0 DEG
|
Facility
|
IP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
|
ACET LNR 28*50-54 20 DEG
|
Facility
|
OP
|
$5,146.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,543.82 |
| Max. Negotiated Rate |
$4,940.22 |
| Rate for Payer: Aetna Commercial |
$3,962.47
|
| Rate for Payer: Anthem Medicaid |
$1,769.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.93
|
| Rate for Payer: Cash Price |
$2,573.03
|
| Rate for Payer: Cigna Commercial |
$4,271.23
|
| Rate for Payer: First Health Commercial |
$4,888.76
|
| Rate for Payer: Humana Commercial |
$4,374.15
|
| Rate for Payer: Humana KY Medicaid |
$1,769.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.78
|
| Rate for Payer: PHCS Commercial |
$4,940.22
|
| Rate for Payer: United Healthcare All Payer |
$4,528.53
|
|
