|
SHELL G7 PPS LTD ACET 44A
|
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
|
|
|
SHELL G7 PPS LTD ACET 44A
|
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 46B
|
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 46B
|
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
|
|
|
SHELL G7 PPS LTD ACET 48C
|
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
|
|
|
SHELL G7 PPS LTD ACET 48C
|
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 50D
|
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 50D
|
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
|
|
|
SHELL G7 PPS LTD ACET 52E
|
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
|
|
|
SHELL G7 PPS LTD ACET 52E
|
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 54F
|
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 54F
|
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
|
|
|
SHELL G7 PPS LTD ACET 56F
|
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
|
|
|
SHELL G7 PPS LTD ACET 56F
|
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 58G
|
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 58G
|
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
|
|
|
SHELL G7 PPS LTD ACET 60G
|
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
|
|
|
SHELL G7 PPS LTD ACET 60G
|
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 62H
|
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 62H
|
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
|
|
|
SHELL G7 PPS LTD ACET 64H
|
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 64H
|
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
|
|
|
SHELL G7 PPS LTD ACET 66I
|
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 66I
|
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
|
|
|
SHELL G7 PPS LTD ACET 68I
|
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
|
|
