|
CEMENT RESTRICTOR BIOSTOP G 8M
|
Facility
|
IP
|
$2,200.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$2,112.48 |
| Rate for Payer: Aetna Commercial |
$1,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.39
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna Commercial |
$1,826.42
|
| Rate for Payer: First Health Commercial |
$2,090.48
|
| Rate for Payer: Humana Commercial |
$1,870.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.16
|
| Rate for Payer: PHCS Commercial |
$2,112.48
|
| Rate for Payer: United Healthcare All Payer |
$1,936.44
|
|
|
CEMENT RESTRICTOR BIOSTOP G 8M
|
Facility
|
OP
|
$2,200.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$2,112.48 |
| Rate for Payer: Aetna Commercial |
$1,694.38
|
| Rate for Payer: Anthem Medicaid |
$756.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.39
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cigna Commercial |
$1,826.42
|
| Rate for Payer: First Health Commercial |
$2,090.48
|
| Rate for Payer: Humana Commercial |
$1,870.42
|
| Rate for Payer: Humana KY Medicaid |
$756.75
|
| Rate for Payer: Kentucky WC Medicaid |
$764.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.16
|
| Rate for Payer: PHCS Commercial |
$2,112.48
|
| Rate for Payer: United Healthcare All Payer |
$1,936.44
|
|
|
CEMENT SIMPLEX HV 6194-1-010
|
Facility
|
OP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem Medicaid |
$373.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Humana KY Medicaid |
$373.65
|
| Rate for Payer: Kentucky WC Medicaid |
$377.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
CEMENT SIMPLEX HV 6194-1-010
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
CEM HUM STEM W/REMVBL HD7X200
|
Facility
|
OP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem Medicaid |
$7,250.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Humana KY Medicaid |
$7,250.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,324.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,395.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CEM HUM STEM W/REMVBL HD7X200
|
Facility
|
IP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CEM MBT REV SZ 1.5
|
Facility
|
OP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem Medicaid |
$11,128.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Humana KY Medicaid |
$11,128.44
|
| Rate for Payer: Kentucky WC Medicaid |
$11,241.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,351.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
CEM MBT REV SZ 1.5
|
Facility
|
IP
|
$32,359.51
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.74 |
| Max. Negotiated Rate |
$31,065.13 |
| Rate for Payer: Aetna Commercial |
$24,916.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,240.42
|
| Rate for Payer: Cash Price |
$16,179.75
|
| Rate for Payer: Cigna Commercial |
$26,858.39
|
| Rate for Payer: First Health Commercial |
$30,741.53
|
| Rate for Payer: Humana Commercial |
$27,505.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,534.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,707.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,476.37
|
| Rate for Payer: Ohio Health Group HMO |
$24,269.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,471.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,206.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,031.45
|
| Rate for Payer: PHCS Commercial |
$31,065.13
|
| Rate for Payer: United Healthcare All Payer |
$28,476.37
|
|
|
CEMT HUM STM W/REMVBL HD 9X210
|
Facility
|
OP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem Medicaid |
$7,250.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Humana KY Medicaid |
$7,250.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,324.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,395.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CEMT HUM STM W/REMVBL HD 9X210
|
Facility
|
IP
|
$21,082.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.74 |
| Max. Negotiated Rate |
$20,239.34 |
| Rate for Payer: Aetna Commercial |
$16,233.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,444.47
|
| Rate for Payer: Cash Price |
$10,541.33
|
| Rate for Payer: Cigna Commercial |
$17,498.60
|
| Rate for Payer: First Health Commercial |
$20,028.52
|
| Rate for Payer: Humana Commercial |
$17,920.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,287.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,559.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,324.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$15,811.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,740.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,535.62
|
| Rate for Payer: PHCS Commercial |
$20,239.34
|
| Rate for Payer: United Healthcare All Payer |
$18,552.73
|
|
|
CENTAFLEX GRAFT 3X4CM ALLOGRAF
|
Facility
|
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$12,979.20 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
CENTAFLEX GRAFT 3X4CM ALLOGRAF
|
Facility
|
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$12,979.20 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
CENTAFLEX GRAFT 3X6CM ALLOGRAF
|
Facility
|
OP
|
$17,520.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.60 |
| Max. Negotiated Rate |
$16,819.20 |
| Rate for Payer: Aetna Commercial |
$13,490.40
|
| Rate for Payer: Anthem Medicaid |
$6,025.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,665.60
|
| Rate for Payer: Cash Price |
$8,760.00
|
| Rate for Payer: Cigna Commercial |
$14,541.60
|
| Rate for Payer: First Health Commercial |
$16,644.00
|
| Rate for Payer: Humana Commercial |
$14,892.00
|
| Rate for Payer: Humana KY Medicaid |
$6,025.13
|
| Rate for Payer: Kentucky WC Medicaid |
$6,086.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,366.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,929.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,256.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,146.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,417.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,277.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,431.20
|
| Rate for Payer: PHCS Commercial |
$16,819.20
|
| Rate for Payer: United Healthcare All Payer |
$15,417.60
|
|
|
CENTAFLEX GRAFT 3X6CM ALLOGRAF
|
Facility
|
IP
|
$17,520.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.60 |
| Max. Negotiated Rate |
$16,819.20 |
| Rate for Payer: Aetna Commercial |
$13,490.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,665.60
|
| Rate for Payer: Cash Price |
$8,760.00
|
| Rate for Payer: Cigna Commercial |
$14,541.60
|
| Rate for Payer: First Health Commercial |
$16,644.00
|
| Rate for Payer: Humana Commercial |
$14,892.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,366.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,929.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,256.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,417.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,277.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,431.20
|
| Rate for Payer: PHCS Commercial |
$16,819.20
|
| Rate for Payer: United Healthcare All Payer |
$15,417.60
|
|
|
CENTAFLEX GRAFT 3X8CM ALLOGRAF
|
Facility
|
OP
|
$20,860.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.80 |
| Max. Negotiated Rate |
$20,025.60 |
| Rate for Payer: Aetna Commercial |
$16,062.20
|
| Rate for Payer: Anthem Medicaid |
$7,173.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,270.80
|
| Rate for Payer: Cash Price |
$10,430.00
|
| Rate for Payer: Cigna Commercial |
$17,313.80
|
| Rate for Payer: First Health Commercial |
$19,817.00
|
| Rate for Payer: Humana Commercial |
$17,731.00
|
| Rate for Payer: Humana KY Medicaid |
$7,173.75
|
| Rate for Payer: Kentucky WC Medicaid |
$7,246.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,105.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,394.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,258.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,317.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,356.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,711.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,466.60
|
| Rate for Payer: PHCS Commercial |
$20,025.60
|
| Rate for Payer: United Healthcare All Payer |
$18,356.80
|
|
|
CENTAFLEX GRAFT 3X8CM ALLOGRAF
|
Facility
|
IP
|
$20,860.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,711.80 |
| Max. Negotiated Rate |
$20,025.60 |
| Rate for Payer: Aetna Commercial |
$16,062.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,270.80
|
| Rate for Payer: Cash Price |
$10,430.00
|
| Rate for Payer: Cigna Commercial |
$17,313.80
|
| Rate for Payer: First Health Commercial |
$19,817.00
|
| Rate for Payer: Humana Commercial |
$17,731.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,105.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,394.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,258.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,356.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,711.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,466.60
|
| Rate for Payer: PHCS Commercial |
$20,025.60
|
| Rate for Payer: United Healthcare All Payer |
$18,356.80
|
|
|
CENTRAL POST MODULAR 20MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 20MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 25MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 25MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 30MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 30MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 35MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL POST MODULAR 35MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRAL SCREW MODULAR 20MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
