|
SHELL TRILOGY MULTI- HOLE 62MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 64MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 64MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 66MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 66MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 68MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 68MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 70MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 70MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 72MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 72MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 74MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 74MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 76MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 76MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 78MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 78MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 80MM
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRILOGY MULTI- HOLE 80MM
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
SHELL TRIT HEMI SLD BACK 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 TRIT HEMI SLD BACK 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 TRIT HEMI SLD BLACK 48C
|
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 TRIT HEMI SLD BLACK 48C
|
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 TRIT HEMI SLD BLACK 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 TRIT HEMI SLD BLACK 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
|
|
