|
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
|
|
|
REFLECTION SPIKED SHELL 60MM
|
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 60MM
|
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 62MM
|
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 62MM
|
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 64MM
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REFLECTION SPIKED SHELL 64MM
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REFLECTION SPIKED SHELL 66MM
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REFLECTION SPIKED SHELL 66MM
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REFLECTION SPIKED SHELL 68MM
|
Facility
|
IP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REFLECTION SPIKED SHELL 68MM
|
Facility
|
OP
|
$11,084.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.94 |
| Max. Negotiated Rate |
$10,640.80 |
| Rate for Payer: Aetna Commercial |
$8,534.81
|
| Rate for Payer: Anthem Medicaid |
$3,811.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,645.65
|
| Rate for Payer: Cash Price |
$5,542.09
|
| Rate for Payer: Cigna Commercial |
$9,199.86
|
| Rate for Payer: First Health Commercial |
$10,529.96
|
| Rate for Payer: Humana Commercial |
$9,421.54
|
| Rate for Payer: Humana KY Medicaid |
$3,811.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.09
|
| Rate for Payer: PHCS Commercial |
$10,640.80
|
| Rate for Payer: United Healthcare All Payer |
$9,754.07
|
|
|
REFL HA MH SHELL 50MM E
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 50MM E
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 52MM E
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 52MM E
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 54MM F
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 54MM F
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 56MM F
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 56MM F
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 58MM G
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 58MM G
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 60MM G
|
Facility
|
OP
|
$11,549.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.44 |
| Max. Negotiated Rate |
$11,087.57 |
| Rate for Payer: Aetna Commercial |
$8,893.15
|
| Rate for Payer: Anthem Medicaid |
$3,971.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,008.65
|
| Rate for Payer: Cash Price |
$5,774.77
|
| Rate for Payer: Cigna Commercial |
$9,586.13
|
| Rate for Payer: First Health Commercial |
$10,972.07
|
| Rate for Payer: Humana Commercial |
$9,817.12
|
| Rate for Payer: Humana KY Medicaid |
$3,971.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,012.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,470.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,523.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,464.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,051.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,163.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,662.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,309.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,501.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,580.36
|
| Rate for Payer: PHCS Commercial |
$11,087.57
|
| Rate for Payer: United Healthcare All Payer |
$10,163.60
|
|
|
REFL HA MH SHELL 60MM G
|
Facility
|
IP
|
$11,549.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.44 |
| Max. Negotiated Rate |
$11,087.57 |
| Rate for Payer: Aetna Commercial |
$8,893.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,008.65
|
| Rate for Payer: Cash Price |
$5,774.77
|
| Rate for Payer: Cigna Commercial |
$9,586.13
|
| Rate for Payer: First Health Commercial |
$10,972.07
|
| Rate for Payer: Humana Commercial |
$9,817.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,470.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,523.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,464.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,163.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,662.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,309.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,501.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,580.36
|
| Rate for Payer: PHCS Commercial |
$11,087.57
|
| Rate for Payer: United Healthcare All Payer |
$10,163.60
|
|
|
REFL HA MH SHELL 62MM H
|
Facility
|
OP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem Medicaid |
$3,835.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Humana KY Medicaid |
$3,835.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,874.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
|
REFL HA MH SHELL 62MM H
|
Facility
|
IP
|
$11,152.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.82 |
| Max. Negotiated Rate |
$10,706.33 |
| Rate for Payer: Aetna Commercial |
$8,587.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,698.90
|
| Rate for Payer: Cash Price |
$5,576.21
|
| Rate for Payer: Cigna Commercial |
$9,256.52
|
| Rate for Payer: First Health Commercial |
$10,594.81
|
| Rate for Payer: Humana Commercial |
$9,479.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,144.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,230.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,345.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,814.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,364.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,449.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.25
|
| Rate for Payer: PHCS Commercial |
$10,706.33
|
| Rate for Payer: United Healthcare All Payer |
$9,814.14
|
|
