|
SHELL REDAPT FULLY POROUS 50MM
|
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 50MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 52MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 52MM
|
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 54MM
|
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 54MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 56MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 56MM
|
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 58MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 58MM
|
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 60MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 60MM
|
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 62MM
|
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
|
|
|
SHELL REDAPT FULLY POROUS 62MM
|
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 STIKTITETHRDD FSO 9 52MM
|
Facility
|
IP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 52MM
|
Facility
|
OP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem Medicaid |
$4,316.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Humana KY Medicaid |
$4,316.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,360.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 54MM
|
Facility
|
IP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 54MM
|
Facility
|
OP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem Medicaid |
$4,316.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Humana KY Medicaid |
$4,316.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,360.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 56MM
|
Facility
|
OP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem Medicaid |
$4,316.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Humana KY Medicaid |
$4,316.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,360.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 56MM
|
Facility
|
IP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 58MM
|
Facility
|
IP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 58MM
|
Facility
|
OP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem Medicaid |
$4,316.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Humana KY Medicaid |
$4,316.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,360.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 60MM
|
Facility
|
OP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem Medicaid |
$4,316.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Humana KY Medicaid |
$4,316.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,360.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 60MM
|
Facility
|
IP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
|
SHELL STIKTITETHRDD FSO 9 62MM
|
Facility
|
IP
|
$12,552.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.86 |
| Max. Negotiated Rate |
$12,050.64 |
| Rate for Payer: Aetna Commercial |
$9,665.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,791.14
|
| Rate for Payer: Cash Price |
$6,276.38
|
| Rate for Payer: Cigna Commercial |
$10,418.78
|
| Rate for Payer: First Health Commercial |
$11,925.11
|
| Rate for Payer: Humana Commercial |
$10,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,293.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,263.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,765.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,046.42
|
| Rate for Payer: Ohio Health Group HMO |
$9,414.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,510.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,891.35
|
| Rate for Payer: PHCS Commercial |
$12,050.64
|
| Rate for Payer: United Healthcare All Payer |
$11,046.42
|
|
