|
NEW SKIN (COMBINATION) SPR 1OZ
|
Facility
|
OP
|
$11.73
|
|
|
Service Code
|
NDC 16864044001
|
| Hospital Charge Code |
25001070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$11.26 |
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Anthem Medicaid |
$4.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.15
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cigna Commercial |
$9.74
|
| Rate for Payer: First Health Commercial |
$11.14
|
| Rate for Payer: Humana Commercial |
$9.97
|
| Rate for Payer: Humana KY Medicaid |
$4.03
|
| Rate for Payer: Kentucky WC Medicaid |
$4.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.32
|
| Rate for Payer: Ohio Health Group HMO |
$8.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.64
|
| Rate for Payer: PHCS Commercial |
$11.26
|
| Rate for Payer: United Healthcare All Payer |
$10.32
|
|
|
NEXEL TOTELB HMSTM SZ5 150M LG
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HMSTM SZ5 150M LG
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HMSTM SZ5 200M LG
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HMSTM SZ5 200M LG
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HMSTM SZ6 150M LG
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HMSTM SZ6 150M LG
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELB HUM STEM SZ 4 10
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELB HUM STEM SZ 4 10
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ4 150M
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ4 150M
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ5 100M
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ5 100M
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ5 150M
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ5 150M
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ6 200M
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOTELB HUM STEM SZ6 200M
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELB HUM STM SZ6 100M
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELB HUM STM SZ6 100M
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELB HUM STM SZ6 150M
|
Facility
|
OP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem Medicaid |
$8,993.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Humana KY Medicaid |
$8,993.84
|
| Rate for Payer: Kentucky WC Medicaid |
$9,085.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,174.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELB HUM STM SZ6 150M
|
Facility
|
IP
|
$26,152.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,399.82 |
| Max. Negotiated Rate |
$25,106.40 |
| Rate for Payer: Aetna Commercial |
$20,137.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,398.95
|
| Rate for Payer: Cash Price |
$13,076.25
|
| Rate for Payer: Cigna Commercial |
$21,706.58
|
| Rate for Payer: First Health Commercial |
$24,844.88
|
| Rate for Payer: Humana Commercial |
$22,229.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,445.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,300.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,845.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,014.20
|
| Rate for Payer: Ohio Health Group HMO |
$19,614.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,230.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,107.28
|
| Rate for Payer: PHCS Commercial |
$25,106.40
|
| Rate for Payer: United Healthcare All Payer |
$23,014.20
|
|
|
NEXEL TOT ELBOW ART KIT SZ 4
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
NEXEL TOT ELBOW ART KIT SZ 4
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
NEXEL TOT ELBOW ART KIT SZ 5
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
NEXEL TOT ELBOW ART KIT SZ 5
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
