|
SHELL CONT MULTI HOLE 62NN
|
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 62NN
|
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 64OO
|
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 64OO
|
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 66PP
|
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 66PP
|
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 68QU
|
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 68QU
|
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 70RR
|
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 70RR
|
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 72SS
|
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 72SS
|
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 74TT
|
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 74TT
|
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 76UU
|
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 76UU
|
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 78VV
|
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 78VV
|
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 80VV
|
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 80VV
|
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 G7 FINNED 3H 42A
|
Facility
|
IP
|
$9,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.10 |
| Max. Negotiated Rate |
$8,995.20 |
| Rate for Payer: Aetna Commercial |
$7,214.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,308.60
|
| Rate for Payer: Cash Price |
$4,685.00
|
| Rate for Payer: Cigna Commercial |
$7,777.10
|
| Rate for Payer: First Health Commercial |
$8,901.50
|
| Rate for Payer: Humana Commercial |
$7,964.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,683.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,915.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,811.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,245.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.70
|
| Rate for Payer: PHCS Commercial |
$8,995.20
|
| Rate for Payer: United Healthcare All Payer |
$8,245.60
|
|
|
SHELL G7 FINNED 3H 42A
|
Facility
|
OP
|
$9,370.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.10 |
| Max. Negotiated Rate |
$8,995.20 |
| Rate for Payer: Aetna Commercial |
$7,214.90
|
| Rate for Payer: Anthem Medicaid |
$3,222.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,308.60
|
| Rate for Payer: Cash Price |
$4,685.00
|
| Rate for Payer: Cigna Commercial |
$7,777.10
|
| Rate for Payer: First Health Commercial |
$8,901.50
|
| Rate for Payer: Humana Commercial |
$7,964.50
|
| Rate for Payer: Humana KY Medicaid |
$3,222.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,255.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,683.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,915.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,811.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,287.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,245.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,027.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.70
|
| Rate for Payer: PHCS Commercial |
$8,995.20
|
| Rate for Payer: United Healthcare All Payer |
$8,245.60
|
|
|
SHELL G7 FINNED 3H 44A
|
Facility
|
IP
|
$11,841.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.33 |
| Max. Negotiated Rate |
$11,367.36 |
| Rate for Payer: Aetna Commercial |
$9,117.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,235.98
|
| Rate for Payer: Cash Price |
$5,920.50
|
| Rate for Payer: Cigna Commercial |
$9,828.03
|
| Rate for Payer: First Health Commercial |
$11,248.95
|
| Rate for Payer: Humana Commercial |
$10,064.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,709.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,738.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,552.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,420.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,670.71
|
| Rate for Payer: PHCS Commercial |
$11,367.36
|
| Rate for Payer: United Healthcare All Payer |
$10,420.08
|
|
|
SHELL G7 FINNED 3H 44A
|
Facility
|
OP
|
$11,841.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.33 |
| Max. Negotiated Rate |
$11,367.36 |
| Rate for Payer: Aetna Commercial |
$9,117.57
|
| Rate for Payer: Anthem Medicaid |
$4,072.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,235.98
|
| Rate for Payer: Cash Price |
$5,920.50
|
| Rate for Payer: Cigna Commercial |
$9,828.03
|
| Rate for Payer: First Health Commercial |
$11,248.95
|
| Rate for Payer: Humana Commercial |
$10,064.85
|
| Rate for Payer: Humana KY Medicaid |
$4,072.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,113.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,709.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,738.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,552.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,153.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,420.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,670.71
|
| Rate for Payer: PHCS Commercial |
$11,367.36
|
| Rate for Payer: United Healthcare All Payer |
$10,420.08
|
|
|
SHELL G7 FINNED 3H 46B
|
Facility
|
IP
|
$11,841.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,539.33 |
| Max. Negotiated Rate |
$11,367.36 |
| Rate for Payer: Aetna Commercial |
$9,117.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,235.98
|
| Rate for Payer: Cash Price |
$5,920.50
|
| Rate for Payer: Cigna Commercial |
$9,828.03
|
| Rate for Payer: First Health Commercial |
$11,248.95
|
| Rate for Payer: Humana Commercial |
$10,064.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,709.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,738.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,552.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,420.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,880.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,368.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,539.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,670.71
|
| Rate for Payer: PHCS Commercial |
$11,367.36
|
| Rate for Payer: United Healthcare All Payer |
$10,420.08
|
|
