|
SHELL STIKTITETHRDD FSO 9 56MM
|
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 58MM
|
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 58MM
|
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 60MM
|
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 60MM
|
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 62MM
|
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 62MM
|
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 64MM
|
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 64MM
|
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 66MM
|
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 66MM
|
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 68MM
|
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 68MM
|
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 TI-PLASMA/HA NON-CEM 43
|
Facility
|
OP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem Medicaid |
$5,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Humana KY Medicaid |
$5,901.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 43
|
Facility
|
IP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 45
|
Facility
|
IP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 45
|
Facility
|
OP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem Medicaid |
$5,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Humana KY Medicaid |
$5,901.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 47
|
Facility
|
IP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 47
|
Facility
|
OP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem Medicaid |
$5,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Humana KY Medicaid |
$5,901.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 49
|
Facility
|
IP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 49
|
Facility
|
OP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem Medicaid |
$5,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Humana KY Medicaid |
$5,901.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 51
|
Facility
|
IP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 51
|
Facility
|
OP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem Medicaid |
$5,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Humana KY Medicaid |
$5,901.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 53
|
Facility
|
IP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
|
SHELL TI-PLASMA/HA NON-CEM 53
|
Facility
|
OP
|
$17,160.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,148.11 |
| Max. Negotiated Rate |
$16,473.96 |
| Rate for Payer: Aetna Commercial |
$13,213.49
|
| Rate for Payer: Anthem Medicaid |
$5,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,385.10
|
| Rate for Payer: Cash Price |
$8,580.19
|
| Rate for Payer: Cigna Commercial |
$14,243.12
|
| Rate for Payer: First Health Commercial |
$16,302.36
|
| Rate for Payer: Humana Commercial |
$14,586.32
|
| Rate for Payer: Humana KY Medicaid |
$5,901.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,101.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,728.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,929.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,840.66
|
| Rate for Payer: PHCS Commercial |
$16,473.96
|
| Rate for Payer: United Healthcare All Payer |
$15,101.13
|
|
