|
STEM REJUVENATE MOD SZ 10
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 10
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 11
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 11
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 12
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 12
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 7
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 7
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 8
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 8
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 9
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MOD SZ 9
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
STEM REJUVENATE MONO 127^ SZ 6
|
Facility
|
IP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 127^ SZ 6
|
Facility
|
OP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem Medicaid |
$7,110.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Humana KY Medicaid |
$7,110.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,253.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 132^ SZ 4
|
Facility
|
OP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem Medicaid |
$7,110.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Humana KY Medicaid |
$7,110.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,253.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 132^ SZ 4
|
Facility
|
IP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 132^ SZ 5
|
Facility
|
IP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 132^ SZ 5
|
Facility
|
OP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem Medicaid |
$7,110.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Humana KY Medicaid |
$7,110.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,253.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 132^ SZ 6
|
Facility
|
OP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem Medicaid |
$7,110.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Humana KY Medicaid |
$7,110.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,253.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REJUVENATE MONO 132^ SZ 6
|
Facility
|
IP
|
$20,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,688.08 |
| Max. Negotiated Rate |
$19,850.40 |
| Rate for Payer: Aetna Commercial |
$15,921.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,128.45
|
| Rate for Payer: Cash Price |
$10,338.75
|
| Rate for Payer: Cigna Commercial |
$17,162.32
|
| Rate for Payer: First Health Commercial |
$19,643.62
|
| Rate for Payer: Humana Commercial |
$17,575.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,955.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,260.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,203.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,196.20
|
| Rate for Payer: Ohio Health Group HMO |
$15,508.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,688.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,410.02
|
| Rate for Payer: PHCS Commercial |
$19,850.40
|
| Rate for Payer: United Healthcare All Payer |
$18,196.20
|
|
|
STEM REV 3D COATED SZ 10
|
Facility
|
IP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 10
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
|
STEM REV 3D COATED SZ 11
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM REV 3D COATED SZ 11
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
STEM REV 3D COATED SZ 12
|
Facility
|
OP
|
$14,195.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.38 |
| Max. Negotiated Rate |
$13,627.44 |
| Rate for Payer: Aetna Commercial |
$10,930.34
|
| Rate for Payer: Anthem Medicaid |
$4,881.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,072.30
|
| Rate for Payer: Cash Price |
$7,097.62
|
| Rate for Payer: Cigna Commercial |
$11,782.06
|
| Rate for Payer: First Health Commercial |
$13,485.49
|
| Rate for Payer: Humana Commercial |
$12,065.96
|
| Rate for Payer: Humana KY Medicaid |
$4,881.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4,931.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,640.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,476.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,258.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,979.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,491.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,646.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,839.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.53
|
| Rate for Payer: PHCS Commercial |
$13,627.44
|
| Rate for Payer: United Healthcare All Payer |
$12,491.82
|
|
