|
SHELL POLARCUP CEMENTED 61
|
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 61
|
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 63
|
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 63
|
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 REDAPT FULLY POROUS 48MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 48MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 50MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 50MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 52MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 52MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 54MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 54MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 56MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 56MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 58MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 58MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 60MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 60MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 62MM
|
Facility
|
IP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL REDAPT FULLY POROUS 62MM
|
Facility
|
OP
|
$13,655.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,096.52 |
| Max. Negotiated Rate |
$13,108.87 |
| Rate for Payer: Aetna Commercial |
$10,514.40
|
| Rate for Payer: Anthem Medicaid |
$4,695.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.95
|
| Rate for Payer: Cash Price |
$6,827.54
|
| Rate for Payer: Cigna Commercial |
$11,333.71
|
| Rate for Payer: First Health Commercial |
$12,972.32
|
| Rate for Payer: Humana Commercial |
$11,606.81
|
| Rate for Payer: Humana KY Medicaid |
$4,695.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,197.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,077.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,790.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,016.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,241.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,924.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,879.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,422.00
|
| Rate for Payer: PHCS Commercial |
$13,108.87
|
| Rate for Payer: United Healthcare All Payer |
$12,016.46
|
|
|
SHELL STIKTITETHRDD FSO 9 52MM
|
Facility
|
IP
|
$12,803.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,841.03 |
| Max. Negotiated Rate |
$12,291.31 |
| Rate for Payer: Aetna Commercial |
$9,858.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,986.69
|
| Rate for Payer: Cash Price |
$6,401.73
|
| Rate for Payer: Cigna Commercial |
$10,626.86
|
| Rate for Payer: First Health Commercial |
$12,163.28
|
| Rate for Payer: Humana Commercial |
$10,882.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,498.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,448.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,267.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,602.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,242.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,139.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,834.38
|
| Rate for Payer: PHCS Commercial |
$12,291.31
|
| Rate for Payer: United Healthcare All Payer |
$11,267.04
|
|
|
SHELL STIKTITETHRDD FSO 9 52MM
|
Facility
|
OP
|
$12,803.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,841.03 |
| Max. Negotiated Rate |
$12,291.31 |
| Rate for Payer: Aetna Commercial |
$9,858.66
|
| Rate for Payer: Anthem Medicaid |
$4,403.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,986.69
|
| Rate for Payer: Cash Price |
$6,401.73
|
| Rate for Payer: Cigna Commercial |
$10,626.86
|
| Rate for Payer: First Health Commercial |
$12,163.28
|
| Rate for Payer: Humana Commercial |
$10,882.93
|
| Rate for Payer: Humana KY Medicaid |
$4,403.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,447.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,498.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,448.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,491.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,267.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,602.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,242.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,139.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,834.38
|
| Rate for Payer: PHCS Commercial |
$12,291.31
|
| Rate for Payer: United Healthcare All Payer |
$11,267.04
|
|
|
SHELL STIKTITETHRDD FSO 9 54MM
|
Facility
|
IP
|
$12,803.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,841.03 |
| Max. Negotiated Rate |
$12,291.31 |
| Rate for Payer: Aetna Commercial |
$9,858.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,986.69
|
| Rate for Payer: Cash Price |
$6,401.73
|
| Rate for Payer: Cigna Commercial |
$10,626.86
|
| Rate for Payer: First Health Commercial |
$12,163.28
|
| Rate for Payer: Humana Commercial |
$10,882.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,498.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,448.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,267.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,602.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,242.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,139.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,834.38
|
| Rate for Payer: PHCS Commercial |
$12,291.31
|
| Rate for Payer: United Healthcare All Payer |
$11,267.04
|
|
|
SHELL STIKTITETHRDD FSO 9 54MM
|
Facility
|
OP
|
$12,803.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,841.03 |
| Max. Negotiated Rate |
$12,291.31 |
| Rate for Payer: Aetna Commercial |
$9,858.66
|
| Rate for Payer: Anthem Medicaid |
$4,403.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,986.69
|
| Rate for Payer: Cash Price |
$6,401.73
|
| Rate for Payer: Cigna Commercial |
$10,626.86
|
| Rate for Payer: First Health Commercial |
$12,163.28
|
| Rate for Payer: Humana Commercial |
$10,882.93
|
| Rate for Payer: Humana KY Medicaid |
$4,403.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,447.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,498.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,448.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,491.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,267.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,602.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,242.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,139.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,834.38
|
| Rate for Payer: PHCS Commercial |
$12,291.31
|
| Rate for Payer: United Healthcare All Payer |
$11,267.04
|
|
|
SHELL STIKTITETHRDD FSO 9 56MM
|
Facility
|
OP
|
$12,803.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,841.03 |
| Max. Negotiated Rate |
$12,291.31 |
| Rate for Payer: Aetna Commercial |
$9,858.66
|
| Rate for Payer: Anthem Medicaid |
$4,403.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,986.69
|
| Rate for Payer: Cash Price |
$6,401.73
|
| Rate for Payer: Cigna Commercial |
$10,626.86
|
| Rate for Payer: First Health Commercial |
$12,163.28
|
| Rate for Payer: Humana Commercial |
$10,882.93
|
| Rate for Payer: Humana KY Medicaid |
$4,403.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,447.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,498.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,448.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,841.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,491.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,267.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,602.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,242.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,139.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,834.38
|
| Rate for Payer: PHCS Commercial |
$12,291.31
|
| Rate for Payer: United Healthcare All Payer |
$11,267.04
|
|
