|
RESTOR PS 4/16 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 4/16 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 4/16 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 5/15 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 5/15 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 5/15 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 5/15 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 5/15 BOWD CTD 233MML
|
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 5/15 BOWD CTD 233MML
|
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 5/15 BOWD CTD 233MMR
|
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 5/15 BOWD CTD 233MMR
|
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 5/17 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 5/17 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 5/17 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 5/17 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 6/16 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 6/16 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 6/16 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 6/16 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 6/16 BOWD CTD 234MML
|
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 6/16 BOWD CTD 234MML
|
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 6/16 BOWD CTD 234MMR
|
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 6/16 BOWD CTD 234MMR
|
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 6/18 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 6/18 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
|
|
