|
REFLECTIN ACE LINER28ID*46-48
|
Facility
|
OP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem Medicaid |
$3,124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Humana KY Medicaid |
$3,124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTIN ACE LINER28ID*46-48
|
Facility
|
IP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTIN ACE LINER32ID*62-64
|
Facility
|
OP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem Medicaid |
$3,124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Humana KY Medicaid |
$3,124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTIN ACE LINER32ID*62-64
|
Facility
|
IP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTIN ACE LINER32ID*66-68
|
Facility
|
OP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem Medicaid |
$3,124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Humana KY Medicaid |
$3,124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTIN ACE LINER32ID*66-68
|
Facility
|
IP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTION ACE LINER 32ID*70
|
Facility
|
IP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTION ACE LINER 32ID*70
|
Facility
|
OP
|
$9,085.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.64 |
| Max. Negotiated Rate |
$8,722.04 |
| Rate for Payer: Aetna Commercial |
$6,995.80
|
| Rate for Payer: Anthem Medicaid |
$3,124.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.66
|
| Rate for Payer: Cash Price |
$4,542.73
|
| Rate for Payer: Cigna Commercial |
$7,540.93
|
| Rate for Payer: First Health Commercial |
$8,631.19
|
| Rate for Payer: Humana Commercial |
$7,722.64
|
| Rate for Payer: Humana KY Medicaid |
$3,124.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,450.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,705.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,814.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,268.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,904.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,268.97
|
| Rate for Payer: PHCS Commercial |
$8,722.04
|
| Rate for Payer: United Healthcare All Payer |
$7,995.20
|
|
|
REFLECTION SPIKED SHELL 40MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 40MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 42MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 42MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 44MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 44MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 46MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 46MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 48MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 48MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 50MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 50MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 52MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 52MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 54MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 54MM
|
Facility
|
OP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem Medicaid |
$3,857.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Humana KY Medicaid |
$3,857.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,896.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,934.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
|
REFLECTION SPIKED SHELL 56MM
|
Facility
|
IP
|
$11,217.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.13 |
| Max. Negotiated Rate |
$10,768.41 |
| Rate for Payer: Aetna Commercial |
$8,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,749.33
|
| Rate for Payer: Cash Price |
$5,608.55
|
| Rate for Payer: Cigna Commercial |
$9,310.18
|
| Rate for Payer: First Health Commercial |
$10,656.24
|
| Rate for Payer: Humana Commercial |
$9,534.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,198.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,278.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,412.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,973.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,758.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,739.79
|
| Rate for Payer: PHCS Commercial |
$10,768.41
|
| Rate for Payer: United Healthcare All Payer |
$9,871.04
|
|
