|
CEM HUM STEM W/REMVBL HD7X200
|
Facility
|
OP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem Medicaid |
$7,472.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Humana KY Medicaid |
$7,472.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,548.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CEM HUM STEM W/REMVBL HD7X200
|
Facility
|
IP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CEM MBT REV SZ 1.5
|
Facility
|
OP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem Medicaid |
$11,456.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Humana KY Medicaid |
$11,456.88
|
| Rate for Payer: Kentucky WC Medicaid |
$11,573.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,686.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
CEM MBT REV SZ 1.5
|
Facility
|
IP
|
$33,314.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,994.37 |
| Max. Negotiated Rate |
$31,981.98 |
| Rate for Payer: Aetna Commercial |
$25,652.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,985.36
|
| Rate for Payer: Cash Price |
$16,657.28
|
| Rate for Payer: Cigna Commercial |
$27,651.08
|
| Rate for Payer: First Health Commercial |
$31,648.83
|
| Rate for Payer: Humana Commercial |
$28,317.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,317.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,586.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,316.81
|
| Rate for Payer: Ohio Health Group HMO |
$24,985.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,983.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,987.05
|
| Rate for Payer: PHCS Commercial |
$31,981.98
|
| Rate for Payer: United Healthcare All Payer |
$29,316.81
|
|
|
CEMT HUM STM W/REMVBL HD 9X210
|
Facility
|
OP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem Medicaid |
$7,472.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Humana KY Medicaid |
$7,472.52
|
| Rate for Payer: Kentucky WC Medicaid |
$7,548.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CEMT HUM STM W/REMVBL HD 9X210
|
Facility
|
IP
|
$21,728.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,518.62 |
| Max. Negotiated Rate |
$20,859.60 |
| Rate for Payer: Aetna Commercial |
$16,731.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,948.42
|
| Rate for Payer: Cash Price |
$10,864.38
|
| Rate for Payer: Cigna Commercial |
$18,034.86
|
| Rate for Payer: First Health Commercial |
$20,642.31
|
| Rate for Payer: Humana Commercial |
$18,469.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,035.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,121.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,296.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,904.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,992.84
|
| Rate for Payer: PHCS Commercial |
$20,859.60
|
| Rate for Payer: United Healthcare All Payer |
$19,121.30
|
|
|
CEN FEM CONE AUGMENT
|
Facility
|
IP
|
$27,236.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,170.81 |
| Max. Negotiated Rate |
$26,146.60 |
| Rate for Payer: Aetna Commercial |
$20,971.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,244.11
|
| Rate for Payer: Cash Price |
$13,618.02
|
| Rate for Payer: Cigna Commercial |
$22,605.91
|
| Rate for Payer: First Health Commercial |
$25,874.24
|
| Rate for Payer: Humana Commercial |
$23,150.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,100.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,170.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,967.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,427.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,788.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,695.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,792.87
|
| Rate for Payer: PHCS Commercial |
$26,146.60
|
| Rate for Payer: United Healthcare All Payer |
$23,967.72
|
|
|
CEN FEM CONE AUGMENT
|
Facility
|
OP
|
$27,236.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,170.81 |
| Max. Negotiated Rate |
$26,146.60 |
| Rate for Payer: Aetna Commercial |
$20,971.75
|
| Rate for Payer: Anthem Medicaid |
$9,366.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,244.11
|
| Rate for Payer: Cash Price |
$13,618.02
|
| Rate for Payer: Cigna Commercial |
$22,605.91
|
| Rate for Payer: First Health Commercial |
$25,874.24
|
| Rate for Payer: Humana Commercial |
$23,150.63
|
| Rate for Payer: Humana KY Medicaid |
$9,366.47
|
| Rate for Payer: Kentucky WC Medicaid |
$9,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,333.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,100.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,170.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,554.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,967.72
|
| Rate for Payer: Ohio Health Group HMO |
$20,427.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,788.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,695.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,792.87
|
| Rate for Payer: PHCS Commercial |
$26,146.60
|
| Rate for Payer: United Healthcare All Payer |
$23,967.72
|
|
|
CENTAFLEX GRAFT 3X4CM ALLOGRAF
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
CENTAFLEX GRAFT 3X4CM ALLOGRAF
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
CENTAFLEX GRAFT 3X6CM ALLOGRAF
|
Facility
|
IP
|
$18,090.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,427.00 |
| Max. Negotiated Rate |
$17,366.40 |
| Rate for Payer: Aetna Commercial |
$13,929.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,110.20
|
| Rate for Payer: Cash Price |
$9,045.00
|
| Rate for Payer: Cigna Commercial |
$15,014.70
|
| Rate for Payer: First Health Commercial |
$17,185.50
|
| Rate for Payer: Humana Commercial |
$15,376.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,833.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,350.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,427.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,919.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,567.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,738.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,482.10
|
| Rate for Payer: PHCS Commercial |
$17,366.40
|
| Rate for Payer: United Healthcare All Payer |
$15,919.20
|
|
|
CENTAFLEX GRAFT 3X6CM ALLOGRAF
|
Facility
|
OP
|
$18,090.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,427.00 |
| Max. Negotiated Rate |
$17,366.40 |
| Rate for Payer: Aetna Commercial |
$13,929.30
|
| Rate for Payer: Anthem Medicaid |
$6,221.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,110.20
|
| Rate for Payer: Cash Price |
$9,045.00
|
| Rate for Payer: Cigna Commercial |
$15,014.70
|
| Rate for Payer: First Health Commercial |
$17,185.50
|
| Rate for Payer: Humana Commercial |
$15,376.50
|
| Rate for Payer: Humana KY Medicaid |
$6,221.15
|
| Rate for Payer: Kentucky WC Medicaid |
$6,284.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,833.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,350.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,427.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,345.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,919.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,567.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,738.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,482.10
|
| Rate for Payer: PHCS Commercial |
$17,366.40
|
| Rate for Payer: United Healthcare All Payer |
$15,919.20
|
|
|
CENTAFLEX GRAFT 3X8CM ALLOGRAF
|
Facility
|
OP
|
$21,500.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem Medicaid |
$7,393.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Humana KY Medicaid |
$7,393.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,469.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,542.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
CENTAFLEX GRAFT 3X8CM ALLOGRAF
|
Facility
|
IP
|
$21,500.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,450.00 |
| Max. Negotiated Rate |
$20,640.00 |
| Rate for Payer: Aetna Commercial |
$16,555.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,770.00
|
| Rate for Payer: Cash Price |
$10,750.00
|
| Rate for Payer: Cigna Commercial |
$17,845.00
|
| Rate for Payer: First Health Commercial |
$20,425.00
|
| Rate for Payer: Humana Commercial |
$18,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,867.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,920.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,705.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,835.00
|
| Rate for Payer: PHCS Commercial |
$20,640.00
|
| Rate for Payer: United Healthcare All Payer |
$18,920.00
|
|
|
CENTRAL POST MODULAR 20MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 20MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 25MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 25MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 30MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 30MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 35MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL POST MODULAR 35MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL SCREW MODULAR 20MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRAL SCREW MODULAR 20MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CENTRUM (MULTI VIT/MIN) T 1TAB
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 904264172
|
| Hospital Charge Code |
25000405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.02
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
