|
SHELL G7 PPS LTD ACET 68I
|
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 POLARCUP CEMENTED 43
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 43
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 45
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 45
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 47
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 47
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 49
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 49
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 51
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 51
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 53
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 53
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 55
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 55
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 57
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 57
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 59
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 59
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 61
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 61
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 63
|
Facility
|
IP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL POLARCUP CEMENTED 63
|
Facility
|
OP
|
$13,620.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,770.65 |
| Max. Negotiated Rate |
$13,075.56 |
| Rate for Payer: Aetna Commercial |
$10,487.69
|
| Rate for Payer: Anthem Medicaid |
$4,684.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,623.90
|
| Rate for Payer: Cash Price |
$6,810.19
|
| Rate for Payer: Cigna Commercial |
$11,304.92
|
| Rate for Payer: First Health Commercial |
$12,939.36
|
| Rate for Payer: Humana Commercial |
$11,577.32
|
| Rate for Payer: Humana KY Medicaid |
$4,684.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,731.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,168.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,051.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,778.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,985.93
|
| Rate for Payer: Ohio Health Group HMO |
$10,215.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,724.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,770.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,222.32
|
| Rate for Payer: PHCS Commercial |
$13,075.56
|
| Rate for Payer: United Healthcare All Payer |
$11,985.93
|
|
|
SHELL REDAPT FULLY POROUS 48MM
|
Facility
|
OP
|
$13,399.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,741.96 |
| Max. Negotiated Rate |
$12,863.74 |
| Rate for Payer: Aetna Commercial |
$10,317.79
|
| Rate for Payer: Anthem Medicaid |
$4,608.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,451.79
|
| Rate for Payer: Cash Price |
$6,699.87
|
| Rate for Payer: Cigna Commercial |
$11,121.78
|
| Rate for Payer: First Health Commercial |
$12,729.74
|
| Rate for Payer: Humana Commercial |
$11,389.77
|
| Rate for Payer: Humana KY Medicaid |
$4,608.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,655.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,987.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,889.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,019.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,700.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,791.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,049.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,679.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,153.92
|
| Rate for Payer: PHCS Commercial |
$12,863.74
|
| Rate for Payer: United Healthcare All Payer |
$11,791.76
|
|
|
SHELL REDAPT FULLY POROUS 48MM
|
Facility
|
IP
|
$13,399.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,741.96 |
| Max. Negotiated Rate |
$12,863.74 |
| Rate for Payer: Aetna Commercial |
$10,317.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,451.79
|
| Rate for Payer: Cash Price |
$6,699.87
|
| Rate for Payer: Cigna Commercial |
$11,121.78
|
| Rate for Payer: First Health Commercial |
$12,729.74
|
| Rate for Payer: Humana Commercial |
$11,389.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,987.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,889.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,019.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,791.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,049.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,679.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,741.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,153.92
|
| Rate for Payer: PHCS Commercial |
$12,863.74
|
| Rate for Payer: United Healthcare All Payer |
$11,791.76
|
|
