|
SHEL TRID 2 TRIT CLSTAHOLE 54E
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 56F
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 56F
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 58F
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 58F
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 60G
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 60G
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 62G
|
Facility
|
IP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRID 2 TRIT CLSTAHOLE 62G
|
Facility
|
OP
|
$8,860.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,658.13 |
| Max. Negotiated Rate |
$8,506.02 |
| Rate for Payer: Aetna Commercial |
$6,822.54
|
| Rate for Payer: Anthem Medicaid |
$3,047.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,911.14
|
| Rate for Payer: Cash Price |
$4,430.22
|
| Rate for Payer: Cigna Commercial |
$7,354.17
|
| Rate for Payer: First Health Commercial |
$8,417.42
|
| Rate for Payer: Humana Commercial |
$7,531.37
|
| Rate for Payer: Humana KY Medicaid |
$3,047.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,078.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,265.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,539.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,658.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,108.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,797.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,645.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,708.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,113.70
|
| Rate for Payer: PHCS Commercial |
$8,506.02
|
| Rate for Payer: United Healthcare All Payer |
$7,797.19
|
|
|
SHEL TRILOGY CLUSTER HOLE 50MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 50MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 52MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 52MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 54MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 54MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 56MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 56MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 58MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 58MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 60MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 60MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 62MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 62MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 64MM
|
Facility
|
OP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem Medicaid |
$2,701.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Humana KY Medicaid |
$2,701.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,728.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,755.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
|
SHEL TRILOGY CLUSTER HOLE 64MM
|
Facility
|
IP
|
$7,854.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,356.35 |
| Max. Negotiated Rate |
$7,540.32 |
| Rate for Payer: Aetna Commercial |
$6,047.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,126.51
|
| Rate for Payer: Cash Price |
$3,927.25
|
| Rate for Payer: Cigna Commercial |
$6,519.23
|
| Rate for Payer: First Health Commercial |
$7,461.77
|
| Rate for Payer: Humana Commercial |
$6,676.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,440.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,796.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,356.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,911.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,890.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,283.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,833.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,419.60
|
| Rate for Payer: PHCS Commercial |
$7,540.32
|
| Rate for Payer: United Healthcare All Payer |
$6,911.96
|
|
