|
MBT STEP WEDGE SZ 2 10MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2 15MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2 15MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2.5 10MM
|
Facility
|
OP
|
$16,073.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,822.05 |
| Max. Negotiated Rate |
$15,430.56 |
| Rate for Payer: Aetna Commercial |
$12,376.59
|
| Rate for Payer: Anthem Medicaid |
$5,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,537.33
|
| Rate for Payer: Cash Price |
$8,036.75
|
| Rate for Payer: Cigna Commercial |
$13,341.00
|
| Rate for Payer: First Health Commercial |
$15,269.83
|
| Rate for Payer: Humana Commercial |
$13,662.48
|
| Rate for Payer: Humana KY Medicaid |
$5,527.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,583.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,180.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,862.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,822.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,638.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,144.68
|
| Rate for Payer: Ohio Health Group HMO |
$12,055.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,858.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,983.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,090.72
|
| Rate for Payer: PHCS Commercial |
$15,430.56
|
| Rate for Payer: United Healthcare All Payer |
$14,144.68
|
|
|
MBT STEP WEDGE SZ 2.5 10MM
|
Facility
|
IP
|
$16,073.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,822.05 |
| Max. Negotiated Rate |
$15,430.56 |
| Rate for Payer: Aetna Commercial |
$12,376.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,537.33
|
| Rate for Payer: Cash Price |
$8,036.75
|
| Rate for Payer: Cigna Commercial |
$13,341.00
|
| Rate for Payer: First Health Commercial |
$15,269.83
|
| Rate for Payer: Humana Commercial |
$13,662.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,180.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,862.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,822.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,144.68
|
| Rate for Payer: Ohio Health Group HMO |
$12,055.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,858.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,983.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,090.72
|
| Rate for Payer: PHCS Commercial |
$15,430.56
|
| Rate for Payer: United Healthcare All Payer |
$14,144.68
|
|
|
MBT STEP WEDGE SZ 2.5 15MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2.5 15MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2.5 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2.5 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 2 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 3 10MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 3 10MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 3 15MM
|
Facility
|
OP
|
$16,073.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,822.05 |
| Max. Negotiated Rate |
$15,430.56 |
| Rate for Payer: Aetna Commercial |
$12,376.59
|
| Rate for Payer: Anthem Medicaid |
$5,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,537.33
|
| Rate for Payer: Cash Price |
$8,036.75
|
| Rate for Payer: Cigna Commercial |
$13,341.00
|
| Rate for Payer: First Health Commercial |
$15,269.83
|
| Rate for Payer: Humana Commercial |
$13,662.48
|
| Rate for Payer: Humana KY Medicaid |
$5,527.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,583.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,180.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,862.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,822.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,638.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,144.68
|
| Rate for Payer: Ohio Health Group HMO |
$12,055.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,858.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,983.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,090.72
|
| Rate for Payer: PHCS Commercial |
$15,430.56
|
| Rate for Payer: United Healthcare All Payer |
$14,144.68
|
|
|
MBT STEP WEDGE SZ 3 15MM
|
Facility
|
IP
|
$16,073.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,822.05 |
| Max. Negotiated Rate |
$15,430.56 |
| Rate for Payer: Aetna Commercial |
$12,376.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,537.33
|
| Rate for Payer: Cash Price |
$8,036.75
|
| Rate for Payer: Cigna Commercial |
$13,341.00
|
| Rate for Payer: First Health Commercial |
$15,269.83
|
| Rate for Payer: Humana Commercial |
$13,662.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,180.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,862.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,822.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,144.68
|
| Rate for Payer: Ohio Health Group HMO |
$12,055.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,858.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,983.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,090.72
|
| Rate for Payer: PHCS Commercial |
$15,430.56
|
| Rate for Payer: United Healthcare All Payer |
$14,144.68
|
|
|
MBT STEP WEDGE SZ 3 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 3 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 4 10MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 4 10MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 4 15MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 4 15MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 4 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 4 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 5 10MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 5 10MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
