|
STEM EXT BMT KNETRL 22*200 BOW
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
STEM EXT CANAL FILL ST 17*140
|
Facility
|
OP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem Medicaid |
$3,143.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Humana KY Medicaid |
$3,143.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,206.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXT CANAL FILL ST 17*140
|
Facility
|
IP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENDER CEMENTED 155MM
|
Facility
|
OP
|
$5,106.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.83 |
| Max. Negotiated Rate |
$4,902.14 |
| Rate for Payer: Aetna Commercial |
$3,931.93
|
| Rate for Payer: Anthem Medicaid |
$1,756.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,982.99
|
| Rate for Payer: Cash Price |
$2,553.20
|
| Rate for Payer: Cigna Commercial |
$4,238.31
|
| Rate for Payer: First Health Commercial |
$4,851.08
|
| Rate for Payer: Humana Commercial |
$4,340.44
|
| Rate for Payer: Humana KY Medicaid |
$1,756.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,773.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,187.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,768.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,531.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,791.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,493.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,829.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,582.98
|
| Rate for Payer: PHCS Commercial |
$4,902.14
|
| Rate for Payer: United Healthcare All Payer |
$4,493.63
|
|
|
STEM EXTENDER CEMENTED 155MM
|
Facility
|
IP
|
$5,106.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.83 |
| Max. Negotiated Rate |
$4,902.14 |
| Rate for Payer: Aetna Commercial |
$3,931.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,982.99
|
| Rate for Payer: Cash Price |
$2,553.20
|
| Rate for Payer: Cigna Commercial |
$4,238.31
|
| Rate for Payer: First Health Commercial |
$4,851.08
|
| Rate for Payer: Humana Commercial |
$4,340.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,187.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,768.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,531.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,493.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,829.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,582.98
|
| Rate for Payer: PHCS Commercial |
$4,902.14
|
| Rate for Payer: United Healthcare All Payer |
$4,493.63
|
|
|
STEM EXTENDER CEMENTED 40MM
|
Facility
|
IP
|
$5,075.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$4,872.58 |
| Rate for Payer: Aetna Commercial |
$3,908.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,958.97
|
| Rate for Payer: Cash Price |
$2,537.80
|
| Rate for Payer: Cigna Commercial |
$4,212.75
|
| Rate for Payer: First Health Commercial |
$4,821.82
|
| Rate for Payer: Humana Commercial |
$4,314.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,161.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,745.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,522.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,806.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.44
|
| Rate for Payer: PHCS Commercial |
$4,872.58
|
| Rate for Payer: United Healthcare All Payer |
$4,466.53
|
|
|
STEM EXTENDER CEMENTED 40MM
|
Facility
|
OP
|
$5,075.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$4,872.58 |
| Rate for Payer: Aetna Commercial |
$3,908.21
|
| Rate for Payer: Anthem Medicaid |
$1,745.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,958.97
|
| Rate for Payer: Cash Price |
$2,537.80
|
| Rate for Payer: Cigna Commercial |
$4,212.75
|
| Rate for Payer: First Health Commercial |
$4,821.82
|
| Rate for Payer: Humana Commercial |
$4,314.26
|
| Rate for Payer: Humana KY Medicaid |
$1,745.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,763.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,161.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,745.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,522.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,780.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,806.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.44
|
| Rate for Payer: PHCS Commercial |
$4,872.58
|
| Rate for Payer: United Healthcare All Payer |
$4,466.53
|
|
|
STEM EXTENDER CEMENTED 80MM
|
Facility
|
IP
|
$5,369.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.05 |
| Max. Negotiated Rate |
$5,154.82 |
| Rate for Payer: Aetna Commercial |
$4,134.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,188.29
|
| Rate for Payer: Cash Price |
$2,684.80
|
| Rate for Payer: Cigna Commercial |
$4,456.77
|
| Rate for Payer: First Health Commercial |
$5,101.12
|
| Rate for Payer: Humana Commercial |
$4,564.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,403.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,962.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,725.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,027.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,664.58
|
| Rate for Payer: PHCS Commercial |
$5,154.82
|
| Rate for Payer: United Healthcare All Payer |
$4,725.25
|
|
|
STEM EXTENDER CEMENTED 80MM
|
Facility
|
OP
|
$5,369.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.05 |
| Max. Negotiated Rate |
$5,154.82 |
| Rate for Payer: Aetna Commercial |
$4,134.59
|
| Rate for Payer: Anthem Medicaid |
$1,846.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,188.29
|
| Rate for Payer: Cash Price |
$2,684.80
|
| Rate for Payer: Cigna Commercial |
$4,456.77
|
| Rate for Payer: First Health Commercial |
$5,101.12
|
| Rate for Payer: Humana Commercial |
$4,564.16
|
| Rate for Payer: Humana KY Medicaid |
$1,846.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,865.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,403.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,962.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,883.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,725.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,027.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,664.58
|
| Rate for Payer: PHCS Commercial |
$5,154.82
|
| Rate for Payer: United Healthcare All Payer |
$4,725.25
|
|
|
STEM EXTENSION FLTED ST 10*65M
|
Facility
|
IP
|
$9,132.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.26 |
| Max. Negotiated Rate |
$8,767.44 |
| Rate for Payer: Aetna Commercial |
$7,032.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,123.54
|
| Rate for Payer: Cash Price |
$4,566.38
|
| Rate for Payer: Cigna Commercial |
$7,580.18
|
| Rate for Payer: First Health Commercial |
$8,676.11
|
| Rate for Payer: Humana Commercial |
$7,762.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.15
|
| Rate for Payer: PHCS Commercial |
$8,767.44
|
| Rate for Payer: United Healthcare All Payer |
$8,036.82
|
|
|
STEM EXTENSION FLTED ST 10*65M
|
Facility
|
OP
|
$9,132.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.26 |
| Max. Negotiated Rate |
$8,767.44 |
| Rate for Payer: Aetna Commercial |
$7,032.22
|
| Rate for Payer: Anthem Medicaid |
$3,140.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,123.54
|
| Rate for Payer: Cash Price |
$4,566.38
|
| Rate for Payer: Cigna Commercial |
$7,580.18
|
| Rate for Payer: First Health Commercial |
$8,676.11
|
| Rate for Payer: Humana Commercial |
$7,762.84
|
| Rate for Payer: Humana KY Medicaid |
$3,140.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,488.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,739.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,036.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,849.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.15
|
| Rate for Payer: PHCS Commercial |
$8,767.44
|
| Rate for Payer: United Healthcare All Payer |
$8,036.82
|
|
|
STEM EXTENSION FLTED ST 12X100
|
Facility
|
OP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem Medicaid |
$3,143.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Humana KY Medicaid |
$3,143.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,206.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLTED ST 12X100
|
Facility
|
IP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLTED ST 14X100
|
Facility
|
IP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLTED ST 14X100
|
Facility
|
OP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem Medicaid |
$3,143.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Humana KY Medicaid |
$3,143.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,206.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLUTED ST 12X65
|
Facility
|
OP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem Medicaid |
$3,143.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Humana KY Medicaid |
$3,143.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,206.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLUTED ST 12X65
|
Facility
|
IP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLUTED ST 14X65
|
Facility
|
OP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem Medicaid |
$3,143.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Humana KY Medicaid |
$3,143.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,206.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLUTED ST 14X65
|
Facility
|
IP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLUTED ST 16X10
|
Facility
|
OP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem Medicaid |
$3,143.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Humana KY Medicaid |
$3,143.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,175.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,206.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION FLUTED ST 16X10
|
Facility
|
IP
|
$9,140.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.21 |
| Max. Negotiated Rate |
$8,774.45 |
| Rate for Payer: Aetna Commercial |
$7,037.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,129.24
|
| Rate for Payer: Cash Price |
$4,570.02
|
| Rate for Payer: Cigna Commercial |
$7,586.24
|
| Rate for Payer: First Health Commercial |
$8,683.05
|
| Rate for Payer: Humana Commercial |
$7,769.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,494.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,745.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,742.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,043.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,855.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,188.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,833.42
|
| Rate for Payer: PHCS Commercial |
$8,774.45
|
| Rate for Payer: United Healthcare All Payer |
$8,043.24
|
|
|
STEM EXTENSION GB BMT 10X40
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 10X40
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 10X80
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 10X80
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
