|
SHELL G7 PPS LTD ACET 62H
|
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 64H
|
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 64H
|
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 66I
|
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 66I
|
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 68I
|
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 68I
|
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 POLARCUP CEMENTED 43
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 43
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 45
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 45
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 47
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 47
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 49
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 49
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 51
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 51
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 53
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 53
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 55
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 55
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 57
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 57
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 59
|
Facility
|
IP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
|
SHELL POLARCUP CEMENTED 59
|
Facility
|
OP
|
$13,876.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,163.08 |
| Max. Negotiated Rate |
$13,321.84 |
| Rate for Payer: Aetna Commercial |
$10,685.23
|
| Rate for Payer: Anthem Medicaid |
$4,772.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,824.00
|
| Rate for Payer: Cash Price |
$6,938.46
|
| Rate for Payer: Cigna Commercial |
$11,517.84
|
| Rate for Payer: First Health Commercial |
$13,183.07
|
| Rate for Payer: Humana Commercial |
$11,795.38
|
| Rate for Payer: Humana KY Medicaid |
$4,772.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,820.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,379.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,241.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,163.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,868.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,211.69
|
| Rate for Payer: Ohio Health Group HMO |
$10,407.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,101.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,072.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,575.07
|
| Rate for Payer: PHCS Commercial |
$13,321.84
|
| Rate for Payer: United Healthcare All Payer |
$12,211.69
|
|
