|
ACET LNR 28*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 28*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 28*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 28*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 28*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 28*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 28*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 28*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*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 32*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 32*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 32*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 32*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 32*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 32*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 32*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 32*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
|
|
|
ACETYLCHOLN RCPTR BLCKG ANTB
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 86042
|
| Hospital Charge Code |
30002064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.14
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
|
ACETYLCHOLN RCPTR BLCKG ANTB
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 86042
|
| Hospital Charge Code |
30002064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem Medicaid |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.40
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Humana KY Medicaid |
$18.40
|
| Rate for Payer: Humana Medicare Advantage |
$18.40
|
| Rate for Payer: Kentucky WC Medicaid |
$18.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.14
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
|
ACETYLCYSTEINE 20% 10mL
|
Facility
|
IP
|
$34.28
|
|
|
Service Code
|
NDC 63323069210
|
| Hospital Charge Code |
25004180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.74
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cigna Commercial |
$28.45
|
| Rate for Payer: First Health Commercial |
$32.57
|
| Rate for Payer: Humana Commercial |
$29.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.17
|
| Rate for Payer: Ohio Health Group HMO |
$25.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.65
|
| Rate for Payer: PHCS Commercial |
$32.91
|
| Rate for Payer: United Healthcare All Payer |
$30.17
|
|
|
ACETYLCYSTEINE 20% 10mL
|
Facility
|
OP
|
$34.28
|
|
|
Service Code
|
NDC 63323069210
|
| Hospital Charge Code |
25004180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: Anthem Medicaid |
$11.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.74
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cigna Commercial |
$28.45
|
| Rate for Payer: First Health Commercial |
$32.57
|
| Rate for Payer: Humana Commercial |
$29.14
|
| Rate for Payer: Humana KY Medicaid |
$11.79
|
| Rate for Payer: Kentucky WC Medicaid |
$11.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.17
|
| Rate for Payer: Ohio Health Group HMO |
$25.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.65
|
| Rate for Payer: PHCS Commercial |
$32.91
|
| Rate for Payer: United Healthcare All Payer |
$30.17
|
|
|
ACHILLES SPDBRG KT 3.9MM
|
Facility
|
IP
|
$16,221.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,866.45 |
| Max. Negotiated Rate |
$15,572.64 |
| Rate for Payer: Aetna Commercial |
$12,490.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,652.77
|
| Rate for Payer: Cash Price |
$8,110.75
|
| Rate for Payer: Cigna Commercial |
$13,463.84
|
| Rate for Payer: First Health Commercial |
$15,410.42
|
| Rate for Payer: Humana Commercial |
$13,788.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,301.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,971.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,866.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,274.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,166.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,112.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,192.83
|
| Rate for Payer: PHCS Commercial |
$15,572.64
|
| Rate for Payer: United Healthcare All Payer |
$14,274.92
|
|
|
ACHILLES SPDBRG KT 3.9MM
|
Facility
|
OP
|
$16,221.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,866.45 |
| Max. Negotiated Rate |
$15,572.64 |
| Rate for Payer: Aetna Commercial |
$12,490.56
|
| Rate for Payer: Anthem Medicaid |
$5,578.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,652.77
|
| Rate for Payer: Cash Price |
$8,110.75
|
| Rate for Payer: Cigna Commercial |
$13,463.84
|
| Rate for Payer: First Health Commercial |
$15,410.42
|
| Rate for Payer: Humana Commercial |
$13,788.27
|
| Rate for Payer: Humana KY Medicaid |
$5,578.57
|
| Rate for Payer: Kentucky WC Medicaid |
$5,635.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,301.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,971.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,866.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,690.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,274.92
|
| Rate for Payer: Ohio Health Group HMO |
$12,166.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,112.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,192.83
|
| Rate for Payer: PHCS Commercial |
$15,572.64
|
| Rate for Payer: United Healthcare All Payer |
$14,274.92
|
|
|
ACHILLESTENDONALLOGRAFT
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ACHILLESTENDONALLOGRAFT
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
