|
SHELL TI-PLASMA NON-CEM 53
|
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 55
|
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 55
|
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 57
|
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 57
|
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 59
|
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 59
|
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 61
|
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 61
|
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 63
|
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 63
|
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 65
|
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 65
|
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 67
|
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 67
|
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 TRID2 PSL CLSTRHL HA 42A
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 42A
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 44B
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 44B
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 46C
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 46C
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 48D
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 48D
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 50D
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
SHELL TRID2 PSL CLSTRHL HA 50D
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
