|
RESTORATN PS 3/13 BOW 235MM L
|
Facility
|
IP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 3/13 BOW 235MM L
|
Facility
|
OP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem Medicaid |
$7,866.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Humana KY Medicaid |
$7,866.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,024.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 3/13 BOW 235MM R
|
Facility
|
IP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 3/13 BOW 235MM R
|
Facility
|
OP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem Medicaid |
$7,866.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Humana KY Medicaid |
$7,866.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,024.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 3/15 203MM BOW L
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 3/15 203MM BOW L
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 3/15 203MM BOW R
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 3/15 203MM BOW R
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/14 203MM BOW L
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/14 203MM BOW L
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/14 203MM BOW R
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/14 203MM BOW R
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/14 BOW 234MM L
|
Facility
|
IP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 4/14 BOW 234MM L
|
Facility
|
OP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem Medicaid |
$7,866.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Humana KY Medicaid |
$7,866.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,024.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 4/14 BOW 234MM R
|
Facility
|
OP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem Medicaid |
$7,866.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Humana KY Medicaid |
$7,866.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,024.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 4/14 BOW 234MM R
|
Facility
|
IP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
|
RESTORATN PS 4/16 203MM BOW L
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/16 203MM BOW L
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/16 203MM BOW R
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 4/16 203MM BOW R
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 5/15 203MM BOW L
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 5/15 203MM BOW L
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 5/15 203MM BOW R
|
Facility
|
IP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 5/15 203MM BOW R
|
Facility
|
OP
|
$22,760.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.92 |
| Max. Negotiated Rate |
$21,850.48 |
| Rate for Payer: Aetna Commercial |
$17,525.91
|
| Rate for Payer: Anthem Medicaid |
$7,827.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,753.52
|
| Rate for Payer: Cash Price |
$11,380.46
|
| Rate for Payer: Cigna Commercial |
$18,891.56
|
| Rate for Payer: First Health Commercial |
$21,622.87
|
| Rate for Payer: Humana Commercial |
$19,346.78
|
| Rate for Payer: Humana KY Medicaid |
$7,827.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,907.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,663.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,797.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,828.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,984.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,029.61
|
| Rate for Payer: Ohio Health Group HMO |
$17,070.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,055.89
|
| Rate for Payer: PHCS Commercial |
$21,850.48
|
| Rate for Payer: United Healthcare All Payer |
$20,029.61
|
|
|
RESTORATN PS 5/15 BOW 233MM L
|
Facility
|
IP
|
$22,874.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,973.72 |
| Max. Negotiated Rate |
$21,959.81 |
| Rate for Payer: Aetna Commercial |
$17,613.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,842.34
|
| Rate for Payer: Cash Price |
$11,437.40
|
| Rate for Payer: Cigna Commercial |
$18,986.08
|
| Rate for Payer: First Health Commercial |
$21,731.06
|
| Rate for Payer: Humana Commercial |
$19,443.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,757.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,881.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,862.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,129.82
|
| Rate for Payer: Ohio Health Group HMO |
$17,156.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,973.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,091.19
|
| Rate for Payer: PHCS Commercial |
$21,959.81
|
| Rate for Payer: United Healthcare All Payer |
$20,129.82
|
|
