|
MATERNITY LEVEL 1 PER 15 MIN
|
Facility
|
IP
|
$620.00
|
|
| Hospital Charge Code |
36001263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
MATERNITY LEVEL 1 PER 15 MIN
|
Facility
|
OP
|
$620.00
|
|
| Hospital Charge Code |
36001263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
MATERNITY LEVEL 2 PER 15 MIN
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
36001264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$161.46 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
MATERNITY LEVEL 2 PER 15 MIN
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
36001264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$161.46 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem Medicaid |
$427.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Humana KY Medicaid |
$427.12
|
| Rate for Payer: Kentucky WC Medicaid |
$431.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
MATERNITY LEVEL 3 PER 15 MIN
|
Facility
|
IP
|
$1,862.00
|
|
| Hospital Charge Code |
36001265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$1,787.52 |
| Rate for Payer: Aetna Commercial |
$1,433.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,452.36
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: Cigna Commercial |
$1,545.46
|
| Rate for Payer: First Health Commercial |
$1,768.90
|
| Rate for Payer: Humana Commercial |
$1,582.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,526.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,374.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,638.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.22
|
| Rate for Payer: PHCS Commercial |
$1,787.52
|
| Rate for Payer: United Healthcare All Payer |
$1,638.56
|
|
|
MATERNITY LEVEL 3 PER 15 MIN
|
Facility
|
OP
|
$1,862.00
|
|
| Hospital Charge Code |
36001265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$1,787.52 |
| Rate for Payer: Aetna Commercial |
$1,433.74
|
| Rate for Payer: Anthem Medicaid |
$640.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,452.36
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: Cigna Commercial |
$1,545.46
|
| Rate for Payer: First Health Commercial |
$1,768.90
|
| Rate for Payer: Humana Commercial |
$1,582.70
|
| Rate for Payer: Humana KY Medicaid |
$640.34
|
| Rate for Payer: Kentucky WC Medicaid |
$646.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,526.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,374.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$653.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,638.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$577.22
|
| Rate for Payer: PHCS Commercial |
$1,787.52
|
| Rate for Payer: United Healthcare All Payer |
$1,638.56
|
|
|
MATERNITY LEVEL 4 PER 15 MIN
|
Facility
|
OP
|
$2,570.00
|
|
| Hospital Charge Code |
36001266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.10 |
| Max. Negotiated Rate |
$2,467.20 |
| Rate for Payer: Aetna Commercial |
$1,978.90
|
| Rate for Payer: Anthem Medicaid |
$883.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,004.60
|
| Rate for Payer: Cash Price |
$1,285.00
|
| Rate for Payer: Cigna Commercial |
$2,133.10
|
| Rate for Payer: First Health Commercial |
$2,441.50
|
| Rate for Payer: Humana Commercial |
$2,184.50
|
| Rate for Payer: Humana KY Medicaid |
$883.82
|
| Rate for Payer: Kentucky WC Medicaid |
$892.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,107.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,896.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$771.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$901.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,261.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,927.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$514.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.70
|
| Rate for Payer: PHCS Commercial |
$2,467.20
|
| Rate for Payer: United Healthcare All Payer |
$2,261.60
|
|
|
MATERNITY LEVEL 4 PER 15 MIN
|
Facility
|
IP
|
$2,570.00
|
|
| Hospital Charge Code |
36001266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$334.10 |
| Max. Negotiated Rate |
$2,467.20 |
| Rate for Payer: Aetna Commercial |
$1,978.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,004.60
|
| Rate for Payer: Cash Price |
$1,285.00
|
| Rate for Payer: Cigna Commercial |
$2,133.10
|
| Rate for Payer: First Health Commercial |
$2,441.50
|
| Rate for Payer: Humana Commercial |
$2,184.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,107.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,896.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$771.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,261.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,927.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$514.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.70
|
| Rate for Payer: PHCS Commercial |
$2,467.20
|
| Rate for Payer: United Healthcare All Payer |
$2,261.60
|
|
|
MATERNITY ROOM RATE
|
Facility
|
IP
|
$3,294.00
|
|
| Hospital Charge Code |
11000005
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$428.22 |
| Max. Negotiated Rate |
$3,162.24 |
| Rate for Payer: Aetna Commercial |
$2,536.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.32
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cigna Commercial |
$2,734.02
|
| Rate for Payer: First Health Commercial |
$3,129.30
|
| Rate for Payer: Humana Commercial |
$2,799.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,701.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.14
|
| Rate for Payer: PHCS Commercial |
$3,162.24
|
| Rate for Payer: United Healthcare All Payer |
$2,898.72
|
|
|
MATRISTEM MATRIX 10CM*15CM
|
Facility
|
IP
|
$15,540.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
MATRISTEM MATRIX 10CM*15CM
|
Facility
|
OP
|
$15,540.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,020.20 |
| Max. Negotiated Rate |
$14,918.40 |
| Rate for Payer: Aetna Commercial |
$11,965.80
|
| Rate for Payer: Anthem Medicaid |
$5,344.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,121.20
|
| Rate for Payer: Cash Price |
$7,770.00
|
| Rate for Payer: Cigna Commercial |
$12,898.20
|
| Rate for Payer: First Health Commercial |
$14,763.00
|
| Rate for Payer: Humana Commercial |
$13,209.00
|
| Rate for Payer: Humana KY Medicaid |
$5,344.21
|
| Rate for Payer: Kentucky WC Medicaid |
$5,398.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,742.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,468.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,662.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,451.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,675.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,817.40
|
| Rate for Payer: PHCS Commercial |
$14,918.40
|
| Rate for Payer: United Healthcare All Payer |
$13,675.20
|
|
|
MATRISTEM MATRIX 4CM*12CM
|
Facility
|
OP
|
$6,479.20
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$842.30 |
| Max. Negotiated Rate |
$6,220.03 |
| Rate for Payer: Aetna Commercial |
$4,988.98
|
| Rate for Payer: Anthem Medicaid |
$2,228.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,053.78
|
| Rate for Payer: Cash Price |
$3,239.60
|
| Rate for Payer: Cigna Commercial |
$5,377.74
|
| Rate for Payer: First Health Commercial |
$6,155.24
|
| Rate for Payer: Humana Commercial |
$5,507.32
|
| Rate for Payer: Humana KY Medicaid |
$2,228.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,250.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,312.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,781.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,272.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,701.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,859.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,008.55
|
| Rate for Payer: PHCS Commercial |
$6,220.03
|
| Rate for Payer: United Healthcare All Payer |
$5,701.70
|
|
|
MATRISTEM MATRIX 4CM*12CM
|
Facility
|
IP
|
$6,479.20
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$842.30 |
| Max. Negotiated Rate |
$6,220.03 |
| Rate for Payer: Aetna Commercial |
$4,988.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,053.78
|
| Rate for Payer: Cash Price |
$3,239.60
|
| Rate for Payer: Cigna Commercial |
$5,377.74
|
| Rate for Payer: First Health Commercial |
$6,155.24
|
| Rate for Payer: Humana Commercial |
$5,507.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,312.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,781.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,943.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,701.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,859.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,008.55
|
| Rate for Payer: PHCS Commercial |
$6,220.03
|
| Rate for Payer: United Healthcare All Payer |
$5,701.70
|
|
|
MATRISTEM MATRIX 5CM*5CM
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
MATRISTEM MATRIX 5CM*5CM
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
MATRISTEM MATRIX 6CM*15CM
|
Facility
|
OP
|
$9,698.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,260.80 |
| Max. Negotiated Rate |
$9,310.56 |
| Rate for Payer: Aetna Commercial |
$7,467.84
|
| Rate for Payer: Anthem Medicaid |
$3,335.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.83
|
| Rate for Payer: Cash Price |
$4,849.25
|
| Rate for Payer: Cigna Commercial |
$8,049.76
|
| Rate for Payer: First Health Commercial |
$9,213.58
|
| Rate for Payer: Humana Commercial |
$8,243.72
|
| Rate for Payer: Humana KY Medicaid |
$3,335.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,369.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,402.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,939.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,006.54
|
| Rate for Payer: PHCS Commercial |
$9,310.56
|
| Rate for Payer: United Healthcare All Payer |
$8,534.68
|
|
|
MATRISTEM MATRIX 6CM*15CM
|
Facility
|
IP
|
$9,698.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,260.80 |
| Max. Negotiated Rate |
$9,310.56 |
| Rate for Payer: Aetna Commercial |
$7,467.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.83
|
| Rate for Payer: Cash Price |
$4,849.25
|
| Rate for Payer: Cigna Commercial |
$8,049.76
|
| Rate for Payer: First Health Commercial |
$9,213.58
|
| Rate for Payer: Humana Commercial |
$8,243.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,939.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,006.54
|
| Rate for Payer: PHCS Commercial |
$9,310.56
|
| Rate for Payer: United Healthcare All Payer |
$8,534.68
|
|
|
MATRISTEM MATRIX 7CM*10CM
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
MATRISTEM MATRIX 7CM*10CM
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
MATRISTEM MATRIX 7CM*15CM
|
Facility
|
IP
|
$9,698.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,260.80 |
| Max. Negotiated Rate |
$9,310.56 |
| Rate for Payer: Aetna Commercial |
$7,467.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.83
|
| Rate for Payer: Cash Price |
$4,849.25
|
| Rate for Payer: Cigna Commercial |
$8,049.76
|
| Rate for Payer: First Health Commercial |
$9,213.58
|
| Rate for Payer: Humana Commercial |
$8,243.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,939.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,006.54
|
| Rate for Payer: PHCS Commercial |
$9,310.56
|
| Rate for Payer: United Healthcare All Payer |
$8,534.68
|
|
|
MATRISTEM MATRIX 7CM*15CM
|
Facility
|
OP
|
$9,698.50
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,260.80 |
| Max. Negotiated Rate |
$9,310.56 |
| Rate for Payer: Aetna Commercial |
$7,467.84
|
| Rate for Payer: Anthem Medicaid |
$3,335.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,564.83
|
| Rate for Payer: Cash Price |
$4,849.25
|
| Rate for Payer: Cigna Commercial |
$8,049.76
|
| Rate for Payer: First Health Commercial |
$9,213.58
|
| Rate for Payer: Humana Commercial |
$8,243.72
|
| Rate for Payer: Humana KY Medicaid |
$3,335.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,369.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,952.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,909.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,402.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,534.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,273.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,939.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,006.54
|
| Rate for Payer: PHCS Commercial |
$9,310.56
|
| Rate for Payer: United Healthcare All Payer |
$8,534.68
|
|
|
MATRISTEM MATRIX XS 10CM*15CM
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
MATRISTEM MATRIX XS 10CM*15CM
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
MATRISTEM MATRIX XS 4CM*12CM
|
Facility
|
IP
|
$8,056.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
|
MATRISTEM MATRIX XS 4CM*12CM
|
Facility
|
OP
|
$8,056.00
|
|
|
Service Code
|
HCPCS Q4118
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,047.28 |
| Max. Negotiated Rate |
$7,733.76 |
| Rate for Payer: Aetna Commercial |
$6,203.12
|
| Rate for Payer: Anthem Medicaid |
$2,770.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.68
|
| Rate for Payer: Cash Price |
$4,028.00
|
| Rate for Payer: Cigna Commercial |
$6,686.48
|
| Rate for Payer: First Health Commercial |
$7,653.20
|
| Rate for Payer: Humana Commercial |
$6,847.60
|
| Rate for Payer: Humana KY Medicaid |
$2,770.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,042.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.36
|
| Rate for Payer: PHCS Commercial |
$7,733.76
|
| Rate for Payer: United Healthcare All Payer |
$7,089.28
|
|
