|
REFLECTIN ACE LINER32ID*62-64
|
Facility
|
IP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
REFLECTIN ACE LINER32ID*62-64
|
Facility
|
OP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem Medicaid |
$3,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Humana KY Medicaid |
$3,055.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,086.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
REFLECTIN ACE LINER32ID*66-68
|
Facility
|
IP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
REFLECTIN ACE LINER32ID*66-68
|
Facility
|
OP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem Medicaid |
$3,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Humana KY Medicaid |
$3,055.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,086.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
REFLECTION ACE LINER 32ID*70
|
Facility
|
IP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
REFLECTION ACE LINER 32ID*70
|
Facility
|
OP
|
$8,885.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.11 |
| Max. Negotiated Rate |
$8,530.04 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Anthem Medicaid |
$3,055.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,930.66
|
| Rate for Payer: Cash Price |
$4,442.73
|
| Rate for Payer: Cigna Commercial |
$7,374.93
|
| Rate for Payer: First Health Commercial |
$8,441.19
|
| Rate for Payer: Humana Commercial |
$7,552.64
|
| Rate for Payer: Humana KY Medicaid |
$3,055.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,086.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,286.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,557.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,665.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,819.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,664.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,754.49
|
| Rate for Payer: PHCS Commercial |
$8,530.04
|
| Rate for Payer: United Healthcare All Payer |
$7,819.20
|
|
|
REFLECTION SPIKED SHELL 40MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 40MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 42MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 42MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 44MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 44MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 46MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 46MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 48MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 48MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 50MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 50MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 52MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 52MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 54MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 54MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 56MM
|
Facility
|
IP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 56MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
|
REFLECTION SPIKED SHELL 58MM
|
Facility
|
OP
|
$10,975.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.76 |
| Max. Negotiated Rate |
$10,536.04 |
| Rate for Payer: Aetna Commercial |
$8,450.78
|
| Rate for Payer: Anthem Medicaid |
$3,774.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,560.53
|
| Rate for Payer: Cash Price |
$5,487.52
|
| Rate for Payer: Cigna Commercial |
$9,109.28
|
| Rate for Payer: First Health Commercial |
$10,426.29
|
| Rate for Payer: Humana Commercial |
$9,328.78
|
| Rate for Payer: Humana KY Medicaid |
$3,774.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,812.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,999.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,099.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,292.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,658.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,231.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.26
|
| Rate for Payer: PHCS Commercial |
$10,536.04
|
| Rate for Payer: United Healthcare All Payer |
$9,658.04
|
|
