|
RESTORATN PS 9/21 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 9/21 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 9/21 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 9/21 BOW 250MM 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 9/21 BOW 250MM 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 9/21 BOW 250MM 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 9/21 BOW 250MM 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
|
|
|
RESTORIL 7.5 MG CAPSULE
|
Facility
|
IP
|
$63.01
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
25001320
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.49 |
| Rate for Payer: Aetna Commercial |
$48.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.15
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.30
|
| Rate for Payer: First Health Commercial |
$59.86
|
| Rate for Payer: Humana Commercial |
$53.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.45
|
| Rate for Payer: Ohio Health Group HMO |
$47.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.49
|
| Rate for Payer: United Healthcare All Payer |
$55.45
|
|
|
RESTORIL 7.5 MG CAPSULE
|
Facility
|
OP
|
$63.01
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
25001320
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.49 |
| Rate for Payer: Aetna Commercial |
$48.52
|
| Rate for Payer: Anthem Medicaid |
$21.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.15
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.30
|
| Rate for Payer: First Health Commercial |
$59.86
|
| Rate for Payer: Humana Commercial |
$53.56
|
| Rate for Payer: Humana KY Medicaid |
$21.67
|
| Rate for Payer: Kentucky WC Medicaid |
$21.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.45
|
| Rate for Payer: Ohio Health Group HMO |
$47.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.49
|
| Rate for Payer: United Healthcare All Payer |
$55.45
|
|
|
RESTOR PS 1/11 165M RVHIP STEM
|
Facility
|
OP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem Medicaid |
$7,068.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Humana KY Medicaid |
$7,068.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 1/11 165M RVHIP STEM
|
Facility
|
IP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 1/11 203M RVHIP STEM
|
Facility
|
OP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem Medicaid |
$7,068.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Humana KY Medicaid |
$7,068.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 1/11 203M RVHIP STEM
|
Facility
|
IP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 1/13 165M RVHIP STEM
|
Facility
|
IP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 1/13 165M RVHIP STEM
|
Facility
|
OP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem Medicaid |
$7,068.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Humana KY Medicaid |
$7,068.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 1/13 203M RVHIP STEM
|
Facility
|
OP
|
$21,814.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,835.93 |
| Max. Negotiated Rate |
$20,942.25 |
| Rate for Payer: Aetna Commercial |
$16,797.43
|
| Rate for Payer: Anthem Medicaid |
$7,502.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,015.58
|
| Rate for Payer: Cash Price |
$10,907.42
|
| Rate for Payer: Cigna Commercial |
$18,106.32
|
| Rate for Payer: First Health Commercial |
$20,724.10
|
| Rate for Payer: Humana Commercial |
$18,542.61
|
| Rate for Payer: Humana KY Medicaid |
$7,502.12
|
| Rate for Payer: Kentucky WC Medicaid |
$7,578.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,888.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,099.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,544.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,652.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,197.06
|
| Rate for Payer: Ohio Health Group HMO |
$16,361.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,362.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,835.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,762.60
|
| Rate for Payer: PHCS Commercial |
$20,942.25
|
| Rate for Payer: United Healthcare All Payer |
$19,197.06
|
|
|
RESTOR PS 1/13 203M RVHIP STEM
|
Facility
|
IP
|
$21,814.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,835.93 |
| Max. Negotiated Rate |
$20,942.25 |
| Rate for Payer: Aetna Commercial |
$16,797.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,015.58
|
| Rate for Payer: Cash Price |
$10,907.42
|
| Rate for Payer: Cigna Commercial |
$18,106.32
|
| Rate for Payer: First Health Commercial |
$20,724.10
|
| Rate for Payer: Humana Commercial |
$18,542.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,888.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,099.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,544.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,197.06
|
| Rate for Payer: Ohio Health Group HMO |
$16,361.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,362.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,835.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,762.60
|
| Rate for Payer: PHCS Commercial |
$20,942.25
|
| Rate for Payer: United Healthcare All Payer |
$19,197.06
|
|
|
RESTOR PS 2/12 165M RVHIP STEM
|
Facility
|
OP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem Medicaid |
$7,068.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Humana KY Medicaid |
$7,068.31
|
| Rate for Payer: Kentucky WC Medicaid |
$7,140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 2/12 165M RVHIP STEM
|
Facility
|
IP
|
$20,553.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.94 |
| Max. Negotiated Rate |
$19,731.26 |
| Rate for Payer: Aetna Commercial |
$15,826.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,031.65
|
| Rate for Payer: Cash Price |
$10,276.70
|
| Rate for Payer: Cigna Commercial |
$17,059.32
|
| Rate for Payer: First Health Commercial |
$19,525.73
|
| Rate for Payer: Humana Commercial |
$17,470.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,853.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,168.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,166.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,086.99
|
| Rate for Payer: Ohio Health Group HMO |
$15,415.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,110.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,371.55
|
| Rate for Payer: PHCS Commercial |
$19,731.26
|
| Rate for Payer: United Healthcare All Payer |
$18,086.99
|
|
|
RESTOR PS 2/12 203M RVHIP STEM
|
Facility
|
OP
|
$23,686.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.25 |
| Max. Negotiated Rate |
$22,739.10 |
| Rate for Payer: Aetna Commercial |
$18,238.65
|
| Rate for Payer: Anthem Medicaid |
$8,145.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,475.52
|
| Rate for Payer: Cash Price |
$11,843.28
|
| Rate for Payer: Cigna Commercial |
$19,659.84
|
| Rate for Payer: First Health Commercial |
$22,502.23
|
| Rate for Payer: Humana Commercial |
$20,133.58
|
| Rate for Payer: Humana KY Medicaid |
$8,145.81
|
| Rate for Payer: Kentucky WC Medicaid |
$8,228.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,422.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,480.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,105.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,309.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,844.17
|
| Rate for Payer: Ohio Health Group HMO |
$17,764.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,737.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,079.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,342.83
|
| Rate for Payer: PHCS Commercial |
$22,739.10
|
| Rate for Payer: United Healthcare All Payer |
$20,844.17
|
|
|
RESTOR PS 2/12 203M RVHIP STEM
|
Facility
|
IP
|
$23,686.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.25 |
| Max. Negotiated Rate |
$22,739.10 |
| Rate for Payer: Aetna Commercial |
$18,238.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,475.52
|
| Rate for Payer: Cash Price |
$11,843.28
|
| Rate for Payer: Cigna Commercial |
$19,659.84
|
| Rate for Payer: First Health Commercial |
$22,502.23
|
| Rate for Payer: Humana Commercial |
$20,133.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,422.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,480.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,105.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,844.17
|
| Rate for Payer: Ohio Health Group HMO |
$17,764.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,737.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,079.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,342.83
|
| Rate for Payer: PHCS Commercial |
$22,739.10
|
| Rate for Payer: United Healthcare All Payer |
$20,844.17
|
|
|
RESTOR PS 2/12 BOWD CTD 237MML
|
Facility
|
OP
|
$23,391.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.91 |
| Max. Negotiated Rate |
$22,455.97 |
| Rate for Payer: Aetna Commercial |
$18,011.56
|
| Rate for Payer: Anthem Medicaid |
$8,044.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,245.48
|
| Rate for Payer: Cash Price |
$11,695.82
|
| Rate for Payer: Cigna Commercial |
$19,415.06
|
| Rate for Payer: First Health Commercial |
$22,222.06
|
| Rate for Payer: Humana Commercial |
$19,882.89
|
| Rate for Payer: Humana KY Medicaid |
$8,044.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,126.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,181.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,263.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,017.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,205.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,584.64
|
| Rate for Payer: Ohio Health Group HMO |
$17,543.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,678.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,040.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,251.41
|
| Rate for Payer: PHCS Commercial |
$22,455.97
|
| Rate for Payer: United Healthcare All Payer |
$20,584.64
|
|
|
RESTOR PS 2/12 BOWD CTD 237MML
|
Facility
|
IP
|
$23,391.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.91 |
| Max. Negotiated Rate |
$22,455.97 |
| Rate for Payer: Aetna Commercial |
$18,011.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,245.48
|
| Rate for Payer: Cash Price |
$11,695.82
|
| Rate for Payer: Cigna Commercial |
$19,415.06
|
| Rate for Payer: First Health Commercial |
$22,222.06
|
| Rate for Payer: Humana Commercial |
$19,882.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,181.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,263.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,017.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,584.64
|
| Rate for Payer: Ohio Health Group HMO |
$17,543.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,678.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,040.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,251.41
|
| Rate for Payer: PHCS Commercial |
$22,455.97
|
| Rate for Payer: United Healthcare All Payer |
$20,584.64
|
|
|
RESTOR PS 2/12 BOWD CTD 237MMR
|
Facility
|
IP
|
$23,391.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.91 |
| Max. Negotiated Rate |
$22,455.97 |
| Rate for Payer: Aetna Commercial |
$18,011.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,245.48
|
| Rate for Payer: Cash Price |
$11,695.82
|
| Rate for Payer: Cigna Commercial |
$19,415.06
|
| Rate for Payer: First Health Commercial |
$22,222.06
|
| Rate for Payer: Humana Commercial |
$19,882.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,181.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,263.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,017.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,584.64
|
| Rate for Payer: Ohio Health Group HMO |
$17,543.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,678.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,040.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,251.41
|
| Rate for Payer: PHCS Commercial |
$22,455.97
|
| Rate for Payer: United Healthcare All Payer |
$20,584.64
|
|
|
RESTOR PS 2/12 BOWD CTD 237MMR
|
Facility
|
OP
|
$23,391.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,040.91 |
| Max. Negotiated Rate |
$22,455.97 |
| Rate for Payer: Aetna Commercial |
$18,011.56
|
| Rate for Payer: Anthem Medicaid |
$8,044.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,245.48
|
| Rate for Payer: Cash Price |
$11,695.82
|
| Rate for Payer: Cigna Commercial |
$19,415.06
|
| Rate for Payer: First Health Commercial |
$22,222.06
|
| Rate for Payer: Humana Commercial |
$19,882.89
|
| Rate for Payer: Humana KY Medicaid |
$8,044.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,126.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,181.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,263.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,017.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,205.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,584.64
|
| Rate for Payer: Ohio Health Group HMO |
$17,543.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,678.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,040.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,251.41
|
| Rate for Payer: PHCS Commercial |
$22,455.97
|
| Rate for Payer: United Healthcare All Payer |
$20,584.64
|
|
