|
RESTORATN PS 9/21 203MM BOW R
|
Facility
|
IP
|
$23,453.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,035.90 |
| Max. Negotiated Rate |
$22,514.88 |
| Rate for Payer: Aetna Commercial |
$18,058.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,293.34
|
| Rate for Payer: Cash Price |
$11,726.50
|
| Rate for Payer: Cigna Commercial |
$19,465.99
|
| Rate for Payer: First Health Commercial |
$22,280.35
|
| Rate for Payer: Humana Commercial |
$19,935.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,231.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,308.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,035.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,638.64
|
| Rate for Payer: Ohio Health Group HMO |
$17,589.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,762.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,404.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,182.57
|
| Rate for Payer: PHCS Commercial |
$22,514.88
|
| Rate for Payer: United Healthcare All Payer |
$20,638.64
|
|
|
RESTORATN PS 9/21 BOW 250MM L
|
Facility
|
OP
|
$23,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,071.00 |
| Max. Negotiated Rate |
$22,627.20 |
| Rate for Payer: Aetna Commercial |
$18,148.90
|
| Rate for Payer: Anthem Medicaid |
$8,105.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,384.60
|
| Rate for Payer: Cash Price |
$11,785.00
|
| Rate for Payer: Cigna Commercial |
$19,563.10
|
| Rate for Payer: First Health Commercial |
$22,391.50
|
| Rate for Payer: Humana Commercial |
$20,034.50
|
| Rate for Payer: Humana KY Medicaid |
$8,105.72
|
| Rate for Payer: Kentucky WC Medicaid |
$8,188.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,327.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,394.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,071.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,268.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,741.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,677.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,505.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,263.30
|
| Rate for Payer: PHCS Commercial |
$22,627.20
|
| Rate for Payer: United Healthcare All Payer |
$20,741.60
|
|
|
RESTORATN PS 9/21 BOW 250MM L
|
Facility
|
IP
|
$23,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,071.00 |
| Max. Negotiated Rate |
$22,627.20 |
| Rate for Payer: Aetna Commercial |
$18,148.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,384.60
|
| Rate for Payer: Cash Price |
$11,785.00
|
| Rate for Payer: Cigna Commercial |
$19,563.10
|
| Rate for Payer: First Health Commercial |
$22,391.50
|
| Rate for Payer: Humana Commercial |
$20,034.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,327.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,394.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,071.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,741.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,677.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,505.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,263.30
|
| Rate for Payer: PHCS Commercial |
$22,627.20
|
| Rate for Payer: United Healthcare All Payer |
$20,741.60
|
|
|
RESTORATN PS 9/21 BOW 250MM R
|
Facility
|
IP
|
$23,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,071.00 |
| Max. Negotiated Rate |
$22,627.20 |
| Rate for Payer: Aetna Commercial |
$18,148.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,384.60
|
| Rate for Payer: Cash Price |
$11,785.00
|
| Rate for Payer: Cigna Commercial |
$19,563.10
|
| Rate for Payer: First Health Commercial |
$22,391.50
|
| Rate for Payer: Humana Commercial |
$20,034.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,327.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,394.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,071.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,741.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,677.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,505.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,263.30
|
| Rate for Payer: PHCS Commercial |
$22,627.20
|
| Rate for Payer: United Healthcare All Payer |
$20,741.60
|
|
|
RESTORATN PS 9/21 BOW 250MM R
|
Facility
|
OP
|
$23,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,071.00 |
| Max. Negotiated Rate |
$22,627.20 |
| Rate for Payer: Aetna Commercial |
$18,148.90
|
| Rate for Payer: Anthem Medicaid |
$8,105.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,384.60
|
| Rate for Payer: Cash Price |
$11,785.00
|
| Rate for Payer: Cigna Commercial |
$19,563.10
|
| Rate for Payer: First Health Commercial |
$22,391.50
|
| Rate for Payer: Humana Commercial |
$20,034.50
|
| Rate for Payer: Humana KY Medicaid |
$8,105.72
|
| Rate for Payer: Kentucky WC Medicaid |
$8,188.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,327.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,394.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,071.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,268.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,741.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,677.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,505.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,263.30
|
| Rate for Payer: PHCS Commercial |
$22,627.20
|
| Rate for Payer: United Healthcare All Payer |
$20,741.60
|
|
|
RESTORIL 7.5 MG CAPSULE
|
Facility
|
OP
|
$63.01
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
25001320
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.90 |
| 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 |
$50.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.48
|
| Rate for Payer: PHCS Commercial |
$60.49
|
| Rate for Payer: United Healthcare All Payer |
$55.45
|
|
|
RESTORIL 7.5 MG CAPSULE
|
Facility
|
IP
|
$63.01
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
25001320
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.90 |
| 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 |
$50.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.48
|
| 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
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem Medicaid |
$7,285.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Humana KY Medicaid |
$7,285.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,359.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,431.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 1/11 165M RVHIP STEM
|
Facility
|
IP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 1/11 203M RVHIP STEM
|
Facility
|
IP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 1/11 203M RVHIP STEM
|
Facility
|
OP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem Medicaid |
$7,285.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Humana KY Medicaid |
$7,285.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,359.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,431.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 1/13 165M RVHIP STEM
|
Facility
|
OP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem Medicaid |
$7,285.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Humana KY Medicaid |
$7,285.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,359.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,431.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 1/13 165M RVHIP STEM
|
Facility
|
IP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 1/13 203M RVHIP STEM
|
Facility
|
IP
|
$22,481.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,744.30 |
| Max. Negotiated Rate |
$21,581.76 |
| Rate for Payer: Aetna Commercial |
$17,310.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,535.18
|
| Rate for Payer: Cash Price |
$11,240.50
|
| Rate for Payer: Cigna Commercial |
$18,659.23
|
| Rate for Payer: First Health Commercial |
$21,356.95
|
| Rate for Payer: Humana Commercial |
$19,108.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,434.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,590.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,744.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,783.28
|
| Rate for Payer: Ohio Health Group HMO |
$16,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,558.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,511.89
|
| Rate for Payer: PHCS Commercial |
$21,581.76
|
| Rate for Payer: United Healthcare All Payer |
$19,783.28
|
|
|
RESTOR PS 1/13 203M RVHIP STEM
|
Facility
|
OP
|
$22,481.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,744.30 |
| Max. Negotiated Rate |
$21,581.76 |
| Rate for Payer: Aetna Commercial |
$17,310.37
|
| Rate for Payer: Anthem Medicaid |
$7,731.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,535.18
|
| Rate for Payer: Cash Price |
$11,240.50
|
| Rate for Payer: Cigna Commercial |
$18,659.23
|
| Rate for Payer: First Health Commercial |
$21,356.95
|
| Rate for Payer: Humana Commercial |
$19,108.85
|
| Rate for Payer: Humana KY Medicaid |
$7,731.22
|
| Rate for Payer: Kentucky WC Medicaid |
$7,809.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,434.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,590.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,744.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,886.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,783.28
|
| Rate for Payer: Ohio Health Group HMO |
$16,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,558.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,511.89
|
| Rate for Payer: PHCS Commercial |
$21,581.76
|
| Rate for Payer: United Healthcare All Payer |
$19,783.28
|
|
|
RESTOR PS 2/12 165M RVHIP STEM
|
Facility
|
OP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem Medicaid |
$7,285.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Humana KY Medicaid |
$7,285.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,359.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,431.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 2/12 165M RVHIP STEM
|
Facility
|
IP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 2/12 203M RVHIP STEM
|
Facility
|
IP
|
$24,404.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,321.20 |
| Max. Negotiated Rate |
$23,427.84 |
| Rate for Payer: Aetna Commercial |
$18,791.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,035.12
|
| Rate for Payer: Cash Price |
$12,202.00
|
| Rate for Payer: Cigna Commercial |
$20,255.32
|
| Rate for Payer: First Health Commercial |
$23,183.80
|
| Rate for Payer: Humana Commercial |
$20,743.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,011.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,010.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,321.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,475.52
|
| Rate for Payer: Ohio Health Group HMO |
$18,303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,231.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,838.76
|
| Rate for Payer: PHCS Commercial |
$23,427.84
|
| Rate for Payer: United Healthcare All Payer |
$21,475.52
|
|
|
RESTOR PS 2/12 203M RVHIP STEM
|
Facility
|
OP
|
$24,404.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,321.20 |
| Max. Negotiated Rate |
$23,427.84 |
| Rate for Payer: Aetna Commercial |
$18,791.08
|
| Rate for Payer: Anthem Medicaid |
$8,392.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,035.12
|
| Rate for Payer: Cash Price |
$12,202.00
|
| Rate for Payer: Cigna Commercial |
$20,255.32
|
| Rate for Payer: First Health Commercial |
$23,183.80
|
| Rate for Payer: Humana Commercial |
$20,743.40
|
| Rate for Payer: Humana KY Medicaid |
$8,392.54
|
| Rate for Payer: Kentucky WC Medicaid |
$8,477.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,011.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,010.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,321.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,560.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,475.52
|
| Rate for Payer: Ohio Health Group HMO |
$18,303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,523.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,231.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,838.76
|
| Rate for Payer: PHCS Commercial |
$23,427.84
|
| Rate for Payer: United Healthcare All Payer |
$21,475.52
|
|
|
RESTOR PS 2/12 BOWD CTD 237MML
|
Facility
|
OP
|
$24,101.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,230.30 |
| Max. Negotiated Rate |
$23,136.96 |
| Rate for Payer: Aetna Commercial |
$18,557.77
|
| Rate for Payer: Anthem Medicaid |
$8,288.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,798.78
|
| Rate for Payer: Cash Price |
$12,050.50
|
| Rate for Payer: Cigna Commercial |
$20,003.83
|
| Rate for Payer: First Health Commercial |
$22,895.95
|
| Rate for Payer: Humana Commercial |
$20,485.85
|
| Rate for Payer: Humana KY Medicaid |
$8,288.33
|
| Rate for Payer: Kentucky WC Medicaid |
$8,372.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,762.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,786.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,454.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,208.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,075.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,967.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,629.69
|
| Rate for Payer: PHCS Commercial |
$23,136.96
|
| Rate for Payer: United Healthcare All Payer |
$21,208.88
|
|
|
RESTOR PS 2/12 BOWD CTD 237MML
|
Facility
|
IP
|
$24,101.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,230.30 |
| Max. Negotiated Rate |
$23,136.96 |
| Rate for Payer: Aetna Commercial |
$18,557.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,798.78
|
| Rate for Payer: Cash Price |
$12,050.50
|
| Rate for Payer: Cigna Commercial |
$20,003.83
|
| Rate for Payer: First Health Commercial |
$22,895.95
|
| Rate for Payer: Humana Commercial |
$20,485.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,762.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,786.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,208.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,075.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,967.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,629.69
|
| Rate for Payer: PHCS Commercial |
$23,136.96
|
| Rate for Payer: United Healthcare All Payer |
$21,208.88
|
|
|
RESTOR PS 2/12 BOWD CTD 237MMR
|
Facility
|
IP
|
$24,101.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,230.30 |
| Max. Negotiated Rate |
$23,136.96 |
| Rate for Payer: Aetna Commercial |
$18,557.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,798.78
|
| Rate for Payer: Cash Price |
$12,050.50
|
| Rate for Payer: Cigna Commercial |
$20,003.83
|
| Rate for Payer: First Health Commercial |
$22,895.95
|
| Rate for Payer: Humana Commercial |
$20,485.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,762.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,786.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,208.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,075.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,967.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,629.69
|
| Rate for Payer: PHCS Commercial |
$23,136.96
|
| Rate for Payer: United Healthcare All Payer |
$21,208.88
|
|
|
RESTOR PS 2/12 BOWD CTD 237MMR
|
Facility
|
OP
|
$24,101.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,230.30 |
| Max. Negotiated Rate |
$23,136.96 |
| Rate for Payer: Aetna Commercial |
$18,557.77
|
| Rate for Payer: Anthem Medicaid |
$8,288.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,798.78
|
| Rate for Payer: Cash Price |
$12,050.50
|
| Rate for Payer: Cigna Commercial |
$20,003.83
|
| Rate for Payer: First Health Commercial |
$22,895.95
|
| Rate for Payer: Humana Commercial |
$20,485.85
|
| Rate for Payer: Humana KY Medicaid |
$8,288.33
|
| Rate for Payer: Kentucky WC Medicaid |
$8,372.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,762.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,786.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,454.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,208.88
|
| Rate for Payer: Ohio Health Group HMO |
$18,075.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,967.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,629.69
|
| Rate for Payer: PHCS Commercial |
$23,136.96
|
| Rate for Payer: United Healthcare All Payer |
$21,208.88
|
|
|
RESTOR PS 2/14 165M RVHIP STEM
|
Facility
|
IP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
|
RESTOR PS 2/14 165M RVHIP STEM
|
Facility
|
OP
|
$21,185.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,355.50 |
| Max. Negotiated Rate |
$20,337.60 |
| Rate for Payer: Aetna Commercial |
$16,312.45
|
| Rate for Payer: Anthem Medicaid |
$7,285.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,524.30
|
| Rate for Payer: Cash Price |
$10,592.50
|
| Rate for Payer: Cigna Commercial |
$17,583.55
|
| Rate for Payer: First Health Commercial |
$20,125.75
|
| Rate for Payer: Humana Commercial |
$18,007.25
|
| Rate for Payer: Humana KY Medicaid |
$7,285.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,359.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,371.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,634.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,355.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,431.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,642.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,430.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,617.65
|
| Rate for Payer: PHCS Commercial |
$20,337.60
|
| Rate for Payer: United Healthcare All Payer |
$18,642.80
|
|
