RESTOR PS 8/18 BOWD CTD 240MMR
|
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 8/20 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 8/20 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 8/20 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 8/20 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 8/20 BOWD CTD 251MML
|
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 8/20 BOWD CTD 251MML
|
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 8/20 BOWD CTD 251MMR
|
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 8/20 BOWD CTD 251MMR
|
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 9/21 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 9/21 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 921 203M REVHIP 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 921 203M REVHIP 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 9/21 BOWD CTD 250MML
|
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 9/21 BOWD CTD 250MML
|
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 9/21 BOWD CTD 250MMR
|
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 9/21 BOWD CTD 250MMR
|
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
|
|
REST PLASM DSTAL STEM 12*127 S
|
Facility
|
IP
|
$13,969.68
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,816.06 |
Max. Negotiated Rate |
$13,410.89 |
Rate for Payer: Aetna Commercial |
$10,756.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,896.35
|
Rate for Payer: Cash Price |
$6,984.84
|
Rate for Payer: Cigna Commercial |
$11,594.83
|
Rate for Payer: First Health Commercial |
$13,271.20
|
Rate for Payer: Humana Commercial |
$11,874.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,455.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,309.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,190.90
|
Rate for Payer: Ohio Health Choice Commercial |
$12,293.32
|
Rate for Payer: Ohio Health Group HMO |
$10,477.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,793.94
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,330.60
|
Rate for Payer: PHCS Commercial |
$13,410.89
|
Rate for Payer: United Healthcare All Payer |
$12,293.32
|
|
REST PLASM DSTAL STEM 12*127 S
|
Facility
|
OP
|
$13,969.68
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,816.06 |
Max. Negotiated Rate |
$13,410.89 |
Rate for Payer: Aetna Commercial |
$10,756.65
|
Rate for Payer: Anthem Medicaid |
$4,804.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,896.35
|
Rate for Payer: Cash Price |
$6,984.84
|
Rate for Payer: Cigna Commercial |
$11,594.83
|
Rate for Payer: First Health Commercial |
$13,271.20
|
Rate for Payer: Humana Commercial |
$11,874.23
|
Rate for Payer: Humana KY Medicaid |
$4,804.17
|
Rate for Payer: Kentucky WC Medicaid |
$4,853.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,455.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,309.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,190.90
|
Rate for Payer: Molina Healthcare Medicaid |
$4,900.56
|
Rate for Payer: Ohio Health Choice Commercial |
$12,293.32
|
Rate for Payer: Ohio Health Group HMO |
$10,477.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,793.94
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,330.60
|
Rate for Payer: PHCS Commercial |
$13,410.89
|
Rate for Payer: United Healthcare All Payer |
$12,293.32
|
|
REST PLASM DSTAL STEM 13*127 S
|
Facility
|
IP
|
$13,969.68
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,816.06 |
Max. Negotiated Rate |
$13,410.89 |
Rate for Payer: Aetna Commercial |
$10,756.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,896.35
|
Rate for Payer: Cash Price |
$6,984.84
|
Rate for Payer: Cigna Commercial |
$11,594.83
|
Rate for Payer: First Health Commercial |
$13,271.20
|
Rate for Payer: Humana Commercial |
$11,874.23
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,455.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,309.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,190.90
|
Rate for Payer: Ohio Health Choice Commercial |
$12,293.32
|
Rate for Payer: Ohio Health Group HMO |
$10,477.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,793.94
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,330.60
|
Rate for Payer: PHCS Commercial |
$13,410.89
|
Rate for Payer: United Healthcare All Payer |
$12,293.32
|
|
REST PLASM DSTAL STEM 13*127 S
|
Facility
|
OP
|
$13,969.68
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,816.06 |
Max. Negotiated Rate |
$13,410.89 |
Rate for Payer: Aetna Commercial |
$10,756.65
|
Rate for Payer: Anthem Medicaid |
$4,804.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,896.35
|
Rate for Payer: Cash Price |
$6,984.84
|
Rate for Payer: Cigna Commercial |
$11,594.83
|
Rate for Payer: First Health Commercial |
$13,271.20
|
Rate for Payer: Humana Commercial |
$11,874.23
|
Rate for Payer: Humana KY Medicaid |
$4,804.17
|
Rate for Payer: Kentucky WC Medicaid |
$4,853.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,455.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,309.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,190.90
|
Rate for Payer: Molina Healthcare Medicaid |
$4,900.56
|
Rate for Payer: Ohio Health Choice Commercial |
$12,293.32
|
Rate for Payer: Ohio Health Group HMO |
$10,477.26
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,793.94
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,330.60
|
Rate for Payer: PHCS Commercial |
$13,410.89
|
Rate for Payer: United Healthcare All Payer |
$12,293.32
|
|
RESTRICTOR MED UNIV CEMENT
|
Facility
|
IP
|
$1,857.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$241.48 |
Max. Negotiated Rate |
$1,783.20 |
Rate for Payer: Aetna Commercial |
$1,430.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
Rate for Payer: Cash Price |
$928.75
|
Rate for Payer: Cigna Commercial |
$1,541.72
|
Rate for Payer: First Health Commercial |
$1,764.62
|
Rate for Payer: Humana Commercial |
$1,578.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
Rate for Payer: PHCS Commercial |
$1,783.20
|
Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
RESTRICTOR MED UNIV CEMENT
|
Facility
|
OP
|
$1,857.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$241.48 |
Max. Negotiated Rate |
$1,783.20 |
Rate for Payer: Aetna Commercial |
$1,430.28
|
Rate for Payer: Anthem Medicaid |
$638.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
Rate for Payer: Cash Price |
$928.75
|
Rate for Payer: Cigna Commercial |
$1,541.72
|
Rate for Payer: First Health Commercial |
$1,764.62
|
Rate for Payer: Humana Commercial |
$1,578.88
|
Rate for Payer: Humana KY Medicaid |
$638.79
|
Rate for Payer: Kentucky WC Medicaid |
$645.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
Rate for Payer: Molina Healthcare Medicaid |
$651.61
|
Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
Rate for Payer: PHCS Commercial |
$1,783.20
|
Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
RESTYLANE L
|
Professional
|
Both
|
$600.00
|
|
Hospital Charge Code |
22200024
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$210.00 |
Max. Negotiated Rate |
$600.00 |
Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
Rate for Payer: Cash Price |
$300.00
|
Rate for Payer: Multiplan PHCS |
$360.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
Rate for Payer: UHCCP Medicaid |
$210.00
|
|
RESTYLANE LYFT
|
Professional
|
Both
|
$675.00
|
|
Hospital Charge Code |
22200029
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$236.25 |
Max. Negotiated Rate |
$675.00 |
Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
Rate for Payer: Cash Price |
$337.50
|
Rate for Payer: Multiplan PHCS |
$405.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
Rate for Payer: UHCCP Medicaid |
$236.25
|
|