|
SHELL TI-PLASMA/HA NON-CEM 55
|
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 55
|
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 57
|
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 57
|
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 59
|
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 59
|
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 61
|
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 61
|
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 63
|
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 63
|
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 65
|
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 65
|
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 67
|
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 67
|
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 NON-CEM 43
|
Facility
|
IP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 43
|
Facility
|
OP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem Medicaid |
$5,743.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Humana KY Medicaid |
$5,743.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 45
|
Facility
|
IP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 45
|
Facility
|
OP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem Medicaid |
$5,743.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Humana KY Medicaid |
$5,743.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 47
|
Facility
|
OP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem Medicaid |
$5,743.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Humana KY Medicaid |
$5,743.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 47
|
Facility
|
IP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 49
|
Facility
|
OP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem Medicaid |
$5,743.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Humana KY Medicaid |
$5,743.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 49
|
Facility
|
IP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 51
|
Facility
|
OP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem Medicaid |
$5,743.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Humana KY Medicaid |
$5,743.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,858.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 51
|
Facility
|
IP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
|
SHELL TI-PLASMA NON-CEM 53
|
Facility
|
IP
|
$16,701.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.47 |
| Max. Negotiated Rate |
$16,033.52 |
| Rate for Payer: Aetna Commercial |
$12,860.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.23
|
| Rate for Payer: Cash Price |
$8,350.79
|
| Rate for Payer: Cigna Commercial |
$13,862.31
|
| Rate for Payer: First Health Commercial |
$15,866.50
|
| Rate for Payer: Humana Commercial |
$14,196.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,695.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,325.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,697.39
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,530.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.09
|
| Rate for Payer: PHCS Commercial |
$16,033.52
|
| Rate for Payer: United Healthcare All Payer |
$14,697.39
|
|
