|
MBT STEP WEDGE SZ 1.5 10MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 1.5 15MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 1.5 15MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 1.5 5MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 1.5 5MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 1 5MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 1 5MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2 10MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2 10MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2 15MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2 15MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2.5 10MM
|
Facility
|
IP
|
$15,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,022.54 |
| Max. Negotiated Rate |
$14,935.68 |
| Rate for Payer: Aetna Commercial |
$11,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,135.24
|
| Rate for Payer: Cash Price |
$7,779.00
|
| Rate for Payer: Cigna Commercial |
$12,913.14
|
| Rate for Payer: First Health Commercial |
$14,780.10
|
| Rate for Payer: Humana Commercial |
$13,224.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,757.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,667.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$11,668.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,111.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.98
|
| Rate for Payer: PHCS Commercial |
$14,935.68
|
| Rate for Payer: United Healthcare All Payer |
$13,691.04
|
|
|
MBT STEP WEDGE SZ 2.5 10MM
|
Facility
|
OP
|
$15,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,022.54 |
| Max. Negotiated Rate |
$14,935.68 |
| Rate for Payer: Aetna Commercial |
$11,979.66
|
| Rate for Payer: Anthem Medicaid |
$5,350.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,135.24
|
| Rate for Payer: Cash Price |
$7,779.00
|
| Rate for Payer: Cigna Commercial |
$12,913.14
|
| Rate for Payer: First Health Commercial |
$14,780.10
|
| Rate for Payer: Humana Commercial |
$13,224.30
|
| Rate for Payer: Humana KY Medicaid |
$5,350.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,404.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,757.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,667.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$11,668.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,111.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.98
|
| Rate for Payer: PHCS Commercial |
$14,935.68
|
| Rate for Payer: United Healthcare All Payer |
$13,691.04
|
|
|
MBT STEP WEDGE SZ 2.5 15MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2.5 15MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2.5 5MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2.5 5MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2 5MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 2 5MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 3 10MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 3 10MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 3 15MM
|
Facility
|
OP
|
$15,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,022.54 |
| Max. Negotiated Rate |
$14,935.68 |
| Rate for Payer: Aetna Commercial |
$11,979.66
|
| Rate for Payer: Anthem Medicaid |
$5,350.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,135.24
|
| Rate for Payer: Cash Price |
$7,779.00
|
| Rate for Payer: Cigna Commercial |
$12,913.14
|
| Rate for Payer: First Health Commercial |
$14,780.10
|
| Rate for Payer: Humana Commercial |
$13,224.30
|
| Rate for Payer: Humana KY Medicaid |
$5,350.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,404.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,757.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,667.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$11,668.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,111.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.98
|
| Rate for Payer: PHCS Commercial |
$14,935.68
|
| Rate for Payer: United Healthcare All Payer |
$13,691.04
|
|
|
MBT STEP WEDGE SZ 3 15MM
|
Facility
|
IP
|
$15,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,022.54 |
| Max. Negotiated Rate |
$14,935.68 |
| Rate for Payer: Aetna Commercial |
$11,979.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,135.24
|
| Rate for Payer: Cash Price |
$7,779.00
|
| Rate for Payer: Cigna Commercial |
$12,913.14
|
| Rate for Payer: First Health Commercial |
$14,780.10
|
| Rate for Payer: Humana Commercial |
$13,224.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,757.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,667.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$11,668.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,111.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.98
|
| Rate for Payer: PHCS Commercial |
$14,935.68
|
| Rate for Payer: United Healthcare All Payer |
$13,691.04
|
|
|
MBT STEP WEDGE SZ 3 5MM
|
Facility
|
IP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
|
MBT STEP WEDGE SZ 3 5MM
|
Facility
|
OP
|
$16,126.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.48 |
| Max. Negotiated Rate |
$15,481.73 |
| Rate for Payer: Aetna Commercial |
$12,417.64
|
| Rate for Payer: Anthem Medicaid |
$5,546.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,578.90
|
| Rate for Payer: Cash Price |
$8,063.40
|
| Rate for Payer: Cigna Commercial |
$13,385.24
|
| Rate for Payer: First Health Commercial |
$15,320.46
|
| Rate for Payer: Humana Commercial |
$13,707.78
|
| Rate for Payer: Humana KY Medicaid |
$5,546.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,602.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,901.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,838.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,657.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,191.58
|
| Rate for Payer: Ohio Health Group HMO |
$12,095.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,225.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,096.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,999.31
|
| Rate for Payer: PHCS Commercial |
$15,481.73
|
| Rate for Payer: United Healthcare All Payer |
$14,191.58
|
|
