|
SHELL TRILOGY ACET SOLID 48MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 50MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 50MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 52MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 52MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 54MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 54MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 56MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 56MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 58MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 58MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 60MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 60MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 62MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 62MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 64MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 64MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 66MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 66MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 68MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 68MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 70MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY ACET SOLID 70MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY CLUSTR HOLE 48MM
|
Facility
|
IP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
|
SHELL TRILOGY CLUSTR HOLE 48MM
|
Facility
|
OP
|
$7,654.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.08 |
| Max. Negotiated Rate |
$7,348.32 |
| Rate for Payer: Aetna Commercial |
$5,893.96
|
| Rate for Payer: Anthem Medicaid |
$2,632.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,970.51
|
| Rate for Payer: Cash Price |
$3,827.25
|
| Rate for Payer: Cigna Commercial |
$6,353.24
|
| Rate for Payer: First Health Commercial |
$7,271.78
|
| Rate for Payer: Humana Commercial |
$6,506.32
|
| Rate for Payer: Humana KY Medicaid |
$2,632.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,659.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,276.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,649.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,685.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,735.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,740.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,530.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$995.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,372.90
|
| Rate for Payer: PHCS Commercial |
$7,348.32
|
| Rate for Payer: United Healthcare All Payer |
$6,735.96
|
|
