|
SHELL TI-PLASMA NON-CEM 59
|
Facility
|
IP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 61
|
Facility
|
IP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 61
|
Facility
|
OP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem Medicaid |
$5,560.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Humana KY Medicaid |
$5,560.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 63
|
Facility
|
IP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 63
|
Facility
|
OP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem Medicaid |
$5,560.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Humana KY Medicaid |
$5,560.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 65
|
Facility
|
IP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 65
|
Facility
|
OP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem Medicaid |
$5,560.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Humana KY Medicaid |
$5,560.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 67
|
Facility
|
IP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TI-PLASMA NON-CEM 67
|
Facility
|
OP
|
$16,169.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.98 |
| Max. Negotiated Rate |
$15,522.34 |
| Rate for Payer: Aetna Commercial |
$12,450.21
|
| Rate for Payer: Anthem Medicaid |
$5,560.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,611.90
|
| Rate for Payer: Cash Price |
$8,084.55
|
| Rate for Payer: Cigna Commercial |
$13,420.35
|
| Rate for Payer: First Health Commercial |
$15,360.64
|
| Rate for Payer: Humana Commercial |
$13,743.74
|
| Rate for Payer: Humana KY Medicaid |
$5,560.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,258.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,850.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,228.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,126.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,233.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.42
|
| Rate for Payer: PHCS Commercial |
$15,522.34
|
| Rate for Payer: United Healthcare All Payer |
$14,228.81
|
|
|
SHELL TRID2 PSL CLSTRHL HA 42A
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 42A
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 44B
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 44B
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 46C
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 46C
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 48D
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 48D
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 50D
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 50D
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 52E
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 52E
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 54E
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 54E
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 56F
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
SHELL TRID2 PSL CLSTRHL HA 56F
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
