|
SHELL G7 FINNED 3H 46B
|
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 48C
|
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 48C
|
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 50D
|
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 50D
|
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 52E
|
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 52E
|
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 4H 54F
|
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 4H 54F
|
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 4H 58G
|
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 4H 58G
|
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 4H 60G
|
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 4H 60G
|
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 4H 62H
|
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 4H 62H
|
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 4H 64H
|
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 4H 64H
|
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 4H 66I
|
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 4H 66I
|
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 4H 68I
|
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 4H 68I
|
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 OSSEO TI 4M 54MM F
|
Facility
|
IP
|
$20,865.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.56 |
| Max. Negotiated Rate |
$20,031.21 |
| Rate for Payer: Aetna Commercial |
$16,066.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,275.36
|
| Rate for Payer: Cash Price |
$10,432.92
|
| Rate for Payer: Cigna Commercial |
$17,318.65
|
| Rate for Payer: First Health Commercial |
$19,822.55
|
| Rate for Payer: Humana Commercial |
$17,735.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,109.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,398.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,259.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,361.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,649.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,173.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,712.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,468.41
|
| Rate for Payer: PHCS Commercial |
$20,031.21
|
| Rate for Payer: United Healthcare All Payer |
$18,361.94
|
|
|
SHELL G7 OSSEO TI 4M 54MM F
|
Facility
|
OP
|
$20,865.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.56 |
| Max. Negotiated Rate |
$20,031.21 |
| Rate for Payer: Aetna Commercial |
$16,066.70
|
| Rate for Payer: Anthem Medicaid |
$7,175.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,275.36
|
| Rate for Payer: Cash Price |
$10,432.92
|
| Rate for Payer: Cigna Commercial |
$17,318.65
|
| Rate for Payer: First Health Commercial |
$19,822.55
|
| Rate for Payer: Humana Commercial |
$17,735.96
|
| Rate for Payer: Humana KY Medicaid |
$7,175.76
|
| Rate for Payer: Kentucky WC Medicaid |
$7,248.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,109.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,398.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,259.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,319.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,361.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,649.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,173.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,712.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,468.41
|
| Rate for Payer: PHCS Commercial |
$20,031.21
|
| Rate for Payer: United Healthcare All Payer |
$18,361.94
|
|
|
SHELL G7 PPS LTD ACET 42A
|
Facility
|
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem Medicaid |
$3,147.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Humana KY Medicaid |
$3,147.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,179.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,210.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
|
SHELL G7 PPS LTD ACET 42A
|
Facility
|
IP
|
$9,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.63 |
| Max. Negotiated Rate |
$8,784.96 |
| Rate for Payer: Aetna Commercial |
$7,046.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,137.78
|
| Rate for Payer: Cash Price |
$4,575.50
|
| Rate for Payer: Cigna Commercial |
$7,595.33
|
| Rate for Payer: First Health Commercial |
$8,693.45
|
| Rate for Payer: Humana Commercial |
$7,778.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,503.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,753.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,052.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,836.81
|
| Rate for Payer: PHCS Commercial |
$8,784.96
|
| Rate for Payer: United Healthcare All Payer |
$8,052.88
|
|
