|
STEM CEMENTED OSS IM 17X300MM
|
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 17X90MM
|
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 17X90MM
|
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 18X150
|
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 18X150
|
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 9X90MM
|
Facility
|
IP
|
$12,892.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.99 |
| Max. Negotiated Rate |
$12,376.51 |
| Rate for Payer: Aetna Commercial |
$9,926.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,055.92
|
| Rate for Payer: Cash Price |
$6,446.10
|
| Rate for Payer: Cigna Commercial |
$10,700.53
|
| Rate for Payer: First Health Commercial |
$12,247.59
|
| Rate for Payer: Humana Commercial |
$10,958.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,571.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,514.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,867.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,345.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,669.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,578.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,996.58
|
| Rate for Payer: PHCS Commercial |
$12,376.51
|
| Rate for Payer: United Healthcare All Payer |
$11,345.14
|
|
|
STEM CEMENTED OSS IM 9X90MM
|
Facility
|
OP
|
$12,892.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.99 |
| Max. Negotiated Rate |
$12,376.51 |
| Rate for Payer: Aetna Commercial |
$9,926.99
|
| Rate for Payer: Anthem Medicaid |
$4,433.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,055.92
|
| Rate for Payer: Cash Price |
$6,446.10
|
| Rate for Payer: Cigna Commercial |
$10,700.53
|
| Rate for Payer: First Health Commercial |
$12,247.59
|
| Rate for Payer: Humana Commercial |
$10,958.37
|
| Rate for Payer: Humana KY Medicaid |
$4,433.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,478.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,571.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,514.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,867.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,522.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,345.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,669.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,578.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,996.58
|
| Rate for Payer: PHCS Commercial |
$12,376.51
|
| Rate for Payer: United Healthcare All Payer |
$11,345.14
|
|
|
STEM CEMNTD OSS SMTH 90ST-10
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CEMNTD OSS SMTH 90ST-10
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CEM PROX TIB OSS 11X150
|
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 CEM PROX TIB OSS 11X150
|
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 CEM PROX TIB OSS 13X150
|
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 CEM PROX TIB OSS 13X150
|
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 CEM PROX TIB OSS 15X150
|
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 CEM PROX TIB OSS 15X150
|
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 CMTED SMTH OSS 150BW-11
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-11
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-12
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-12
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-13
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-13
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-14
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150BW-14
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-11
|
Facility
|
OP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem Medicaid |
$4,137.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Humana KY Medicaid |
$4,137.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,179.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,220.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
|
STEM CMTED SMTH OSS 150ST-11
|
Facility
|
IP
|
$12,030.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.00 |
| Max. Negotiated Rate |
$11,549.57 |
| Rate for Payer: Aetna Commercial |
$9,263.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,384.02
|
| Rate for Payer: Cash Price |
$6,015.40
|
| Rate for Payer: Cigna Commercial |
$9,985.56
|
| Rate for Payer: First Health Commercial |
$11,429.26
|
| Rate for Payer: Humana Commercial |
$10,226.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,865.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,878.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,609.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,587.10
|
| Rate for Payer: Ohio Health Group HMO |
$9,023.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,406.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,729.55
|
| Rate for Payer: PHCS Commercial |
$11,549.57
|
| Rate for Payer: United Healthcare All Payer |
$10,587.10
|
|
