|
SHELL CONT MULTI HOLE 56KK
|
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 56KK
|
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 58LL
|
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 58LL
|
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 60MM
|
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 60MM
|
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 62NN
|
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 62NN
|
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 64OO
|
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 64OO
|
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 66PP
|
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 66PP
|
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 68QU
|
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 68QU
|
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 70RR
|
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 70RR
|
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 72SS
|
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 72SS
|
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 74TT
|
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 74TT
|
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 76UU
|
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 76UU
|
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 78VV
|
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 78VV
|
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 80VV
|
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
|
|
