|
SHELL CONT MULTI HOLE 80VV
|
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 G7 FINNED 3H 42A
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
SHELL G7 FINNED 3H 42A
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
SHELL G7 FINNED 3H 44A
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 44A
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 46B
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 46B
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 48C
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 48C
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 50D
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 50D
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 52E
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 3H 52E
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 54F
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 54F
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 58G
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 58G
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 60G
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 60G
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 62H
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 62H
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 64H
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 64H
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 66I
|
Facility
|
OP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem Medicaid |
$4,156.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Humana KY Medicaid |
$4,156.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
|
SHELL G7 FINNED 4H 66I
|
Facility
|
IP
|
$12,087.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,626.34 |
| Max. Negotiated Rate |
$11,604.29 |
| Rate for Payer: Aetna Commercial |
$9,307.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,428.48
|
| Rate for Payer: Cash Price |
$6,043.90
|
| Rate for Payer: Cigna Commercial |
$10,032.87
|
| Rate for Payer: First Health Commercial |
$11,483.41
|
| Rate for Payer: Humana Commercial |
$10,274.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,912.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,920.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,637.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,065.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,670.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,340.58
|
| Rate for Payer: PHCS Commercial |
$11,604.29
|
| Rate for Payer: United Healthcare All Payer |
$10,637.26
|
|
