|
SHELL G7 FINNED 4H 68I
|
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 68I
|
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 OSSEO TI 4M 54MM F
|
Facility
|
OP
|
$21,506.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.80 |
| Max. Negotiated Rate |
$20,645.76 |
| Rate for Payer: Aetna Commercial |
$16,559.62
|
| Rate for Payer: Anthem Medicaid |
$7,395.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,774.68
|
| Rate for Payer: Cash Price |
$10,753.00
|
| Rate for Payer: Cigna Commercial |
$17,849.98
|
| Rate for Payer: First Health Commercial |
$20,430.70
|
| Rate for Payer: Humana Commercial |
$18,280.10
|
| Rate for Payer: Humana KY Medicaid |
$7,395.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7,471.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,634.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,871.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,451.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,544.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,925.28
|
| Rate for Payer: Ohio Health Group HMO |
$16,129.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,710.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,839.14
|
| Rate for Payer: PHCS Commercial |
$20,645.76
|
| Rate for Payer: United Healthcare All Payer |
$18,925.28
|
|
|
SHELL G7 OSSEO TI 4M 54MM F
|
Facility
|
IP
|
$21,506.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,451.80 |
| Max. Negotiated Rate |
$20,645.76 |
| Rate for Payer: Aetna Commercial |
$16,559.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,774.68
|
| Rate for Payer: Cash Price |
$10,753.00
|
| Rate for Payer: Cigna Commercial |
$17,849.98
|
| Rate for Payer: First Health Commercial |
$20,430.70
|
| Rate for Payer: Humana Commercial |
$18,280.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,634.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,871.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,451.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,925.28
|
| Rate for Payer: Ohio Health Group HMO |
$16,129.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,710.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,839.14
|
| Rate for Payer: PHCS Commercial |
$20,645.76
|
| Rate for Payer: United Healthcare All Payer |
$18,925.28
|
|
|
SHELL G7 PPS LTD ACET 42A
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 42A
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 44A
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 44A
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 46B
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 46B
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 48C
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 48C
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 50D
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 50D
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 52E
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 52E
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 54F
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 54F
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 56F
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 56F
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 58G
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 58G
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 60G
|
Facility
|
OP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem Medicaid |
$3,215.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Humana KY Medicaid |
$3,215.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 60G
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
|
SHELL G7 PPS LTD ACET 62H
|
Facility
|
IP
|
$9,351.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.30 |
| Max. Negotiated Rate |
$8,976.96 |
| Rate for Payer: Aetna Commercial |
$7,200.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,293.78
|
| Rate for Payer: Cash Price |
$4,675.50
|
| Rate for Payer: Cigna Commercial |
$7,761.33
|
| Rate for Payer: First Health Commercial |
$8,883.45
|
| Rate for Payer: Humana Commercial |
$7,948.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,667.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,228.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,135.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,452.19
|
| Rate for Payer: PHCS Commercial |
$8,976.96
|
| Rate for Payer: United Healthcare All Payer |
$8,228.88
|
|
