|
REFLECTION SPIKED SHELL 56MM
|
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 58MM
|
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 58MM
|
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 60MM
|
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 60MM
|
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 62MM
|
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 62MM
|
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 64MM
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REFLECTION SPIKED SHELL 64MM
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REFLECTION SPIKED SHELL 66MM
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REFLECTION SPIKED SHELL 66MM
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REFLECTION SPIKED SHELL 68MM
|
Facility
|
IP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REFLECTION SPIKED SHELL 68MM
|
Facility
|
OP
|
$11,326.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,398.05 |
| Max. Negotiated Rate |
$10,873.76 |
| Rate for Payer: Aetna Commercial |
$8,721.66
|
| Rate for Payer: Anthem Medicaid |
$3,895.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,834.93
|
| Rate for Payer: Cash Price |
$5,663.41
|
| Rate for Payer: Cigna Commercial |
$9,401.27
|
| Rate for Payer: First Health Commercial |
$10,760.49
|
| Rate for Payer: Humana Commercial |
$9,627.81
|
| Rate for Payer: Humana KY Medicaid |
$3,895.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,934.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,288.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,359.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,398.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,973.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,967.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,495.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,061.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,854.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,815.51
|
| Rate for Payer: PHCS Commercial |
$10,873.76
|
| Rate for Payer: United Healthcare All Payer |
$9,967.61
|
|
|
REFL HA MH SHELL 50MM E
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 50MM E
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 52MM E
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 52MM E
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 54MM F
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 54MM F
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 56MM F
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 56MM F
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 58MM G
|
Facility
|
IP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 58MM G
|
Facility
|
OP
|
$11,395.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,418.64 |
| Max. Negotiated Rate |
$10,939.63 |
| Rate for Payer: Aetna Commercial |
$8,774.50
|
| Rate for Payer: Anthem Medicaid |
$3,918.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,888.45
|
| Rate for Payer: Cash Price |
$5,697.73
|
| Rate for Payer: Cigna Commercial |
$9,458.22
|
| Rate for Payer: First Health Commercial |
$10,825.68
|
| Rate for Payer: Humana Commercial |
$9,686.13
|
| Rate for Payer: Humana KY Medicaid |
$3,918.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,958.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,344.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,409.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,418.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,997.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,028.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,546.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,116.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,862.86
|
| Rate for Payer: PHCS Commercial |
$10,939.63
|
| Rate for Payer: United Healthcare All Payer |
$10,028.00
|
|
|
REFL HA MH SHELL 60MM G
|
Facility
|
IP
|
$11,794.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.43 |
| Max. Negotiated Rate |
$11,322.96 |
| Rate for Payer: Aetna Commercial |
$9,081.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,199.91
|
| Rate for Payer: Cash Price |
$5,897.38
|
| Rate for Payer: Cigna Commercial |
$9,789.64
|
| Rate for Payer: First Health Commercial |
$11,205.01
|
| Rate for Payer: Humana Commercial |
$10,025.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,671.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,704.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,379.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,846.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,435.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,261.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,138.38
|
| Rate for Payer: PHCS Commercial |
$11,322.96
|
| Rate for Payer: United Healthcare All Payer |
$10,379.38
|
|
|
REFL HA MH SHELL 60MM G
|
Facility
|
OP
|
$11,794.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,538.43 |
| Max. Negotiated Rate |
$11,322.96 |
| Rate for Payer: Aetna Commercial |
$9,081.96
|
| Rate for Payer: Anthem Medicaid |
$4,056.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,199.91
|
| Rate for Payer: Cash Price |
$5,897.38
|
| Rate for Payer: Cigna Commercial |
$9,789.64
|
| Rate for Payer: First Health Commercial |
$11,205.01
|
| Rate for Payer: Humana Commercial |
$10,025.54
|
| Rate for Payer: Humana KY Medicaid |
$4,056.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,097.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,671.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,704.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,137.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,379.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,846.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,435.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,261.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,138.38
|
| Rate for Payer: PHCS Commercial |
$11,322.96
|
| Rate for Payer: United Healthcare All Payer |
$10,379.38
|
|
