|
SHELL TRILOGY MULTI- HOLE 56MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 58MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 58MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 60MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 60MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 62MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 62MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 64MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 64MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 66MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 66MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 68MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 68MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 70MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 70MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 72MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 72MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 74MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 74MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 76MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 76MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 78MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 78MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 80MM
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
SHELL TRILOGY MULTI- HOLE 80MM
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
