|
SHELL CONT CLUSTER HOLE 76UU
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 78VV
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 78VV
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT MULTI HOLE 40CC
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 40CC
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 42DD
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 42DD
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 44EE
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 44EE
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 46FF
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 46FF
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 48GG
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 48GG
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 50HH
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 50HH
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 52II
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 52II
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 54JJ
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 54JJ
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 56KK
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 56KK
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 58LL
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 58LL
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 60MM
|
Facility
|
IP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
|
SHELL CONT MULTI HOLE 60MM
|
Facility
|
OP
|
$13,355.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,736.25 |
| Max. Negotiated Rate |
$12,821.52 |
| Rate for Payer: Aetna Commercial |
$10,283.93
|
| Rate for Payer: Anthem Medicaid |
$4,593.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,417.48
|
| Rate for Payer: Cash Price |
$6,677.88
|
| Rate for Payer: Cigna Commercial |
$11,085.27
|
| Rate for Payer: First Health Commercial |
$12,687.96
|
| Rate for Payer: Humana Commercial |
$11,352.39
|
| Rate for Payer: Humana KY Medicaid |
$4,593.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,639.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,951.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,856.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,006.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,753.06
|
| Rate for Payer: Ohio Health Group HMO |
$10,016.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.28
|
| Rate for Payer: PHCS Commercial |
$12,821.52
|
| Rate for Payer: United Healthcare All Payer |
$11,753.06
|
|
