|
STEM CEMENTED OSS IM 13X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 13X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 13X225
|
Facility
|
OP
|
$15,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.40 |
| Max. Negotiated Rate |
$14,572.80 |
| Rate for Payer: Aetna Commercial |
$11,688.60
|
| Rate for Payer: Anthem Medicaid |
$5,220.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,840.40
|
| Rate for Payer: Cash Price |
$7,590.00
|
| Rate for Payer: Cigna Commercial |
$12,599.40
|
| Rate for Payer: First Health Commercial |
$14,421.00
|
| Rate for Payer: Humana Commercial |
$12,903.00
|
| Rate for Payer: Humana KY Medicaid |
$5,220.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,273.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,447.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,202.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,358.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,705.80
|
| Rate for Payer: PHCS Commercial |
$14,572.80
|
| Rate for Payer: United Healthcare All Payer |
$13,358.40
|
|
|
STEM CEMENTED OSS IM 13X225
|
Facility
|
IP
|
$15,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.40 |
| Max. Negotiated Rate |
$14,572.80 |
| Rate for Payer: Aetna Commercial |
$11,688.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,840.40
|
| Rate for Payer: Cash Price |
$7,590.00
|
| Rate for Payer: Cigna Commercial |
$12,599.40
|
| Rate for Payer: First Health Commercial |
$14,421.00
|
| Rate for Payer: Humana Commercial |
$12,903.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,447.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,202.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,358.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,705.80
|
| Rate for Payer: PHCS Commercial |
$14,572.80
|
| Rate for Payer: United Healthcare All Payer |
$13,358.40
|
|
|
STEM CEMENTED OSS IM 13X300MM
|
Facility
|
IP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
|
STEM CEMENTED OSS IM 13X300MM
|
Facility
|
OP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem Medicaid |
$5,399.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Humana KY Medicaid |
$5,399.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,454.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,507.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
|
STEM CEMENTED OSS IM 13X90MM
|
Facility
|
OP
|
$12,143.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,578.70 |
| Max. Negotiated Rate |
$11,658.12 |
| Rate for Payer: Aetna Commercial |
$9,350.79
|
| Rate for Payer: Anthem Medicaid |
$4,176.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,472.23
|
| Rate for Payer: Cash Price |
$6,071.94
|
| Rate for Payer: Cigna Commercial |
$10,079.42
|
| Rate for Payer: First Health Commercial |
$11,536.69
|
| Rate for Payer: Humana Commercial |
$10,322.30
|
| Rate for Payer: Humana KY Medicaid |
$4,176.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4,218.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,957.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,962.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,643.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,260.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,686.61
|
| Rate for Payer: Ohio Health Group HMO |
$9,107.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,764.60
|
| Rate for Payer: PHCS Commercial |
$11,658.12
|
| Rate for Payer: United Healthcare All Payer |
$10,686.61
|
|
|
STEM CEMENTED OSS IM 13X90MM
|
Facility
|
IP
|
$12,143.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,578.70 |
| Max. Negotiated Rate |
$11,658.12 |
| Rate for Payer: Aetna Commercial |
$9,350.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,472.23
|
| Rate for Payer: Cash Price |
$6,071.94
|
| Rate for Payer: Cigna Commercial |
$10,079.42
|
| Rate for Payer: First Health Commercial |
$11,536.69
|
| Rate for Payer: Humana Commercial |
$10,322.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,957.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,962.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,643.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,686.61
|
| Rate for Payer: Ohio Health Group HMO |
$9,107.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,764.60
|
| Rate for Payer: PHCS Commercial |
$11,658.12
|
| Rate for Payer: United Healthcare All Payer |
$10,686.61
|
|
|
STEM CEMENTED OSS IM 14X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 14X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 15X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 15X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 15X225
|
Facility
|
OP
|
$13,561.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,762.98 |
| Max. Negotiated Rate |
$13,018.93 |
| Rate for Payer: Aetna Commercial |
$10,442.27
|
| Rate for Payer: Anthem Medicaid |
$4,663.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,577.88
|
| Rate for Payer: Cash Price |
$6,780.70
|
| Rate for Payer: Cigna Commercial |
$11,255.95
|
| Rate for Payer: First Health Commercial |
$12,883.32
|
| Rate for Payer: Humana Commercial |
$11,527.18
|
| Rate for Payer: Humana KY Medicaid |
$4,663.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,711.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,120.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,008.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,068.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,757.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,171.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,712.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,204.03
|
| Rate for Payer: PHCS Commercial |
$13,018.93
|
| Rate for Payer: United Healthcare All Payer |
$11,934.02
|
|
|
STEM CEMENTED OSS IM 15X225
|
Facility
|
IP
|
$13,561.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,762.98 |
| Max. Negotiated Rate |
$13,018.93 |
| Rate for Payer: Aetna Commercial |
$10,442.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,577.88
|
| Rate for Payer: Cash Price |
$6,780.70
|
| Rate for Payer: Cigna Commercial |
$11,255.95
|
| Rate for Payer: First Health Commercial |
$12,883.32
|
| Rate for Payer: Humana Commercial |
$11,527.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,120.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,008.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,068.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,171.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,712.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,204.03
|
| Rate for Payer: PHCS Commercial |
$13,018.93
|
| Rate for Payer: United Healthcare All Payer |
$11,934.02
|
|
|
STEM CEMENTED OSS IM 15X300MM
|
Facility
|
OP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem Medicaid |
$5,399.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Humana KY Medicaid |
$5,399.17
|
| Rate for Payer: Kentucky WC Medicaid |
$5,454.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,507.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
|
STEM CEMENTED OSS IM 15X300MM
|
Facility
|
IP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
|
STEM CEMENTED OSS IM 15X90MM
|
Facility
|
IP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
STEM CEMENTED OSS IM 15X90MM
|
Facility
|
OP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem Medicaid |
$4,727.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Humana KY Medicaid |
$4,727.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,775.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,822.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
STEM CEMENTED OSS IM 16X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 16X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 17X150
|
Facility
|
OP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem Medicaid |
$4,444.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Humana KY Medicaid |
$4,444.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,489.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 17X150
|
Facility
|
IP
|
$12,923.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,680.09 |
| Max. Negotiated Rate |
$12,406.79 |
| Rate for Payer: Aetna Commercial |
$9,951.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,080.52
|
| Rate for Payer: Cash Price |
$6,461.87
|
| Rate for Payer: Cigna Commercial |
$10,726.70
|
| Rate for Payer: First Health Commercial |
$12,277.55
|
| Rate for Payer: Humana Commercial |
$10,985.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,597.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,877.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,372.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,692.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,680.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,006.36
|
| Rate for Payer: PHCS Commercial |
$12,406.79
|
| Rate for Payer: United Healthcare All Payer |
$11,372.89
|
|
|
STEM CEMENTED OSS IM 17X225
|
Facility
|
OP
|
$15,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.40 |
| Max. Negotiated Rate |
$14,572.80 |
| Rate for Payer: Aetna Commercial |
$11,688.60
|
| Rate for Payer: Anthem Medicaid |
$5,220.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,840.40
|
| Rate for Payer: Cash Price |
$7,590.00
|
| Rate for Payer: Cigna Commercial |
$12,599.40
|
| Rate for Payer: First Health Commercial |
$14,421.00
|
| Rate for Payer: Humana Commercial |
$12,903.00
|
| Rate for Payer: Humana KY Medicaid |
$5,220.40
|
| Rate for Payer: Kentucky WC Medicaid |
$5,273.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,447.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,202.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,325.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,358.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,705.80
|
| Rate for Payer: PHCS Commercial |
$14,572.80
|
| Rate for Payer: United Healthcare All Payer |
$13,358.40
|
|
|
STEM CEMENTED OSS IM 17X225
|
Facility
|
IP
|
$15,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,973.40 |
| Max. Negotiated Rate |
$14,572.80 |
| Rate for Payer: Aetna Commercial |
$11,688.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,840.40
|
| Rate for Payer: Cash Price |
$7,590.00
|
| Rate for Payer: Cigna Commercial |
$12,599.40
|
| Rate for Payer: First Health Commercial |
$14,421.00
|
| Rate for Payer: Humana Commercial |
$12,903.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,447.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,202.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,554.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,358.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,973.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,705.80
|
| Rate for Payer: PHCS Commercial |
$14,572.80
|
| Rate for Payer: United Healthcare All Payer |
$13,358.40
|
|
|
STEM CEMENTED OSS IM 17X300MM
|
Facility
|
IP
|
$15,699.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.98 |
| Max. Negotiated Rate |
$15,071.85 |
| Rate for Payer: Aetna Commercial |
$12,088.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,245.88
|
| Rate for Payer: Cash Price |
$7,849.92
|
| Rate for Payer: Cigna Commercial |
$13,030.87
|
| Rate for Payer: First Health Commercial |
$14,914.85
|
| Rate for Payer: Humana Commercial |
$13,344.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,873.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,586.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,709.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,815.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,774.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,139.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.95
|
| Rate for Payer: PHCS Commercial |
$15,071.85
|
| Rate for Payer: United Healthcare All Payer |
$13,815.86
|
|
