|
SHELL TRIT HEMI SLD BLACK 52D
|
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 52D
|
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 56E
|
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 56E
|
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 60F
|
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 60F
|
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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 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
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 48D
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 48D
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 50D
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 50D
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 52E
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 52E
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 54E
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 54E
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 56F
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 56F
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 58F
|
Facility
|
IP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 58F
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 60G
|
Facility
|
OP
|
$8,660.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.86 |
| Max. Negotiated Rate |
$8,314.02 |
| Rate for Payer: Aetna Commercial |
$6,668.54
|
| Rate for Payer: Anthem Medicaid |
$2,978.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,755.14
|
| Rate for Payer: Cash Price |
$4,330.22
|
| Rate for Payer: Cigna Commercial |
$7,188.17
|
| Rate for Payer: First Health Commercial |
$8,227.42
|
| Rate for Payer: Humana Commercial |
$7,361.37
|
| Rate for Payer: Humana KY Medicaid |
$2,978.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,008.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,101.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,391.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,621.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,495.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,125.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.74
|
| Rate for Payer: PHCS Commercial |
$8,314.02
|
| Rate for Payer: United Healthcare All Payer |
$7,621.19
|
|
