|
SHELL CONT CLUSTER HOLE 70RR
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 72SS
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 72SS
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 74TT
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 74TT
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 76UU
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 76UU
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 78VV
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT CLUSTER HOLE 78VV
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
SHELL CONT MULTI HOLE 40CC
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 40CC
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 42DD
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 42DD
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 44EE
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 44EE
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 46FF
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 46FF
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 48GG
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 48GG
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 50HH
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 50HH
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 52II
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 52II
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 54JJ
|
Facility
|
IP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
|
SHELL CONT MULTI HOLE 54JJ
|
Facility
|
OP
|
$13,610.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,083.26 |
| Max. Negotiated Rate |
$13,066.42 |
| Rate for Payer: Aetna Commercial |
$10,480.35
|
| Rate for Payer: Anthem Medicaid |
$4,680.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,616.46
|
| Rate for Payer: Cash Price |
$6,805.42
|
| Rate for Payer: Cigna Commercial |
$11,297.01
|
| Rate for Payer: First Health Commercial |
$12,930.31
|
| Rate for Payer: Humana Commercial |
$11,569.22
|
| Rate for Payer: Humana KY Medicaid |
$4,680.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,728.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,160.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,044.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,083.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,774.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,977.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,208.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,888.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,841.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,391.49
|
| Rate for Payer: PHCS Commercial |
$13,066.42
|
| Rate for Payer: United Healthcare All Payer |
$11,977.55
|
|
