|
NJX SCLRSNT 1 INCMPTNT VEIN
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
76101461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: Aetna Commercial |
$889.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$900.90
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$958.65
|
| Rate for Payer: First Health Commercial |
$1,097.25
|
| Rate for Payer: Humana Commercial |
$981.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.40
|
| Rate for Payer: Ohio Health Group HMO |
$866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.95
|
| Rate for Payer: PHCS Commercial |
$1,108.80
|
| Rate for Payer: United Healthcare All Payer |
$1,016.40
|
|
|
NJX SCLRSNT 1 INCMPTNT VEIN
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
76101461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: Aetna Commercial |
$889.35
|
| Rate for Payer: Anthem Medicaid |
$397.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$900.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$958.65
|
| Rate for Payer: First Health Commercial |
$1,097.25
|
| Rate for Payer: Humana Commercial |
$981.75
|
| Rate for Payer: Humana KY Medicaid |
$397.20
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$401.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.40
|
| Rate for Payer: Ohio Health Group HMO |
$866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.95
|
| Rate for Payer: PHCS Commercial |
$1,108.80
|
| Rate for Payer: United Healthcare All Payer |
$1,016.40
|
|
|
NJX SCLRSNT 1 INCMPTNT VEIN
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
76101461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Ambetter Exchange |
$36.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.41
|
| Rate for Payer: Anthem Medicaid |
$118.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.66
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$209.12
|
| Rate for Payer: Healthspan PPO |
$161.14
|
| Rate for Payer: Humana Medicaid |
$118.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.36
|
| Rate for Payer: Molina Healthcare Passport |
$118.00
|
| Rate for Payer: Multiplan PHCS |
$693.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.29
|
| Rate for Payer: UHCCP Medicaid |
$40.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.38
|
|
|
NJX SCLRSNT 1 INCMPTNT VEIN(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
761P1461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$209.12 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Ambetter Exchange |
$36.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.41
|
| Rate for Payer: Anthem Medicaid |
$118.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.66
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$209.12
|
| Rate for Payer: Healthspan PPO |
$161.14
|
| Rate for Payer: Humana Medicaid |
$118.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$36.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.36
|
| Rate for Payer: Molina Healthcare Passport |
$118.00
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.29
|
| Rate for Payer: UHCCP Medicaid |
$40.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.38
|
|
|
NJX SCLRSNT 1 INCMPTNT VEIN(T
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
761T1461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
NJX SCLRSNT 1 INCMPTNT VEIN(T
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 36470
|
| Hospital Charge Code |
761T1461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.63 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem Medicaid |
$302.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Humana KY Medicaid |
$302.63
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$305.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.20
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
NK REJUV MOD 30MM 127/132 0^ B
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 30MM 127/132 0^ B
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 30MM 127/132 8^ G
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 30MM 127/132 8^ G
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 30MM 127/132 8^ Y
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 30MM 127/132 8^ Y
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 34MM 127/132 0^ B
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 34MM 127/132 0^ B
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 34MM 127/132 8^ G
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 34MM 127/132 8^ G
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 34MM 127/132 8^ Y
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 34MM 127/132 8^ Y
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 38MM 127/132 0^ B
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 38MM 127/132 0^ B
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 38MM 127/132 8^ G
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 38MM 127/132 8^ G
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 38MM 127/132 8^ Y
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 38MM 127/132 8^ Y
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 42MM 127/132 0^ B
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
