|
STEM FEM 12/14 135^ STD SZ 13
|
Facility
|
OP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem Medicaid |
$26,115.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Humana KY Medicaid |
$26,115.27
|
| Rate for Payer: Kentucky WC Medicaid |
$26,381.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,639.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 135^ STD SZ 13
|
Facility
|
IP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 PORO CAL 9IN L
|
Facility
|
OP
|
$88,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,521.43 |
| Max. Negotiated Rate |
$85,081.34 |
| Rate for Payer: Aetna Commercial |
$68,242.33
|
| Rate for Payer: Anthem Medicaid |
$30,478.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69,128.59
|
| Rate for Payer: Cash Price |
$44,313.20
|
| Rate for Payer: Cigna Commercial |
$73,559.91
|
| Rate for Payer: First Health Commercial |
$84,195.08
|
| Rate for Payer: Humana Commercial |
$75,332.44
|
| Rate for Payer: Humana KY Medicaid |
$30,478.62
|
| Rate for Payer: Kentucky WC Medicaid |
$30,788.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,673.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,406.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,587.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,090.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,991.23
|
| Rate for Payer: Ohio Health Group HMO |
$66,469.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,725.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,521.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,474.18
|
| Rate for Payer: PHCS Commercial |
$85,081.34
|
| Rate for Payer: United Healthcare All Payer |
$77,991.23
|
|
|
STEM FEM 12/14 PORO CAL 9IN L
|
Facility
|
IP
|
$88,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,521.43 |
| Max. Negotiated Rate |
$85,081.34 |
| Rate for Payer: Aetna Commercial |
$68,242.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69,128.59
|
| Rate for Payer: Cash Price |
$44,313.20
|
| Rate for Payer: Cigna Commercial |
$73,559.91
|
| Rate for Payer: First Health Commercial |
$84,195.08
|
| Rate for Payer: Humana Commercial |
$75,332.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,673.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,406.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,587.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,991.23
|
| Rate for Payer: Ohio Health Group HMO |
$66,469.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,725.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,521.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,474.18
|
| Rate for Payer: PHCS Commercial |
$85,081.34
|
| Rate for Payer: United Healthcare All Payer |
$77,991.23
|
|
|
STEM FEMORAL TPR 12/14 250MM
|
Facility
|
IP
|
$35,607.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,629.02 |
| Max. Negotiated Rate |
$34,183.51 |
| Rate for Payer: Aetna Commercial |
$27,418.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,774.10
|
| Rate for Payer: Cash Price |
$17,803.91
|
| Rate for Payer: Cigna Commercial |
$29,554.49
|
| Rate for Payer: First Health Commercial |
$33,827.43
|
| Rate for Payer: Humana Commercial |
$30,266.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,198.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,682.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,334.88
|
| Rate for Payer: Ohio Health Group HMO |
$26,705.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,121.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,629.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,038.42
|
| Rate for Payer: PHCS Commercial |
$34,183.51
|
| Rate for Payer: United Healthcare All Payer |
$31,334.88
|
|
|
STEM FEMORAL TPR 12/14 250MM
|
Facility
|
OP
|
$35,607.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,629.02 |
| Max. Negotiated Rate |
$34,183.51 |
| Rate for Payer: Aetna Commercial |
$27,418.02
|
| Rate for Payer: Anthem Medicaid |
$12,245.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,774.10
|
| Rate for Payer: Cash Price |
$17,803.91
|
| Rate for Payer: Cigna Commercial |
$29,554.49
|
| Rate for Payer: First Health Commercial |
$33,827.43
|
| Rate for Payer: Humana Commercial |
$30,266.65
|
| Rate for Payer: Humana KY Medicaid |
$12,245.53
|
| Rate for Payer: Kentucky WC Medicaid |
$12,370.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,198.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,682.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,491.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,334.88
|
| Rate for Payer: Ohio Health Group HMO |
$26,705.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,121.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,629.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,038.42
|
| Rate for Payer: PHCS Commercial |
$34,183.51
|
| Rate for Payer: United Healthcare All Payer |
$31,334.88
|
|
|
STEM FLUTE PS EXT 20X120MM
|
Facility
|
IP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 20X120MM
|
Facility
|
OP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem Medicaid |
$3,039.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Humana KY Medicaid |
$3,039.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,100.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 20X160MM
|
Facility
|
OP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem Medicaid |
$3,039.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Humana KY Medicaid |
$3,039.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,100.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 20X160MM
|
Facility
|
IP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 22X120MM
|
Facility
|
OP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem Medicaid |
$3,039.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Humana KY Medicaid |
$3,039.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,100.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 22X120MM
|
Facility
|
IP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 22X160MM
|
Facility
|
OP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem Medicaid |
$3,039.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Humana KY Medicaid |
$3,039.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,100.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 22X160MM
|
Facility
|
IP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 24X120MM
|
Facility
|
OP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem Medicaid |
$3,039.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Humana KY Medicaid |
$3,039.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,100.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 24X120MM
|
Facility
|
IP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 24X160MM
|
Facility
|
IP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM FLUTE PS EXT 24X160MM
|
Facility
|
OP
|
$8,838.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.94 |
| Max. Negotiated Rate |
$8,484.49 |
| Rate for Payer: Aetna Commercial |
$6,805.27
|
| Rate for Payer: Anthem Medicaid |
$3,039.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,893.65
|
| Rate for Payer: Cash Price |
$4,419.01
|
| Rate for Payer: Cigna Commercial |
$7,335.55
|
| Rate for Payer: First Health Commercial |
$8,396.11
|
| Rate for Payer: Humana Commercial |
$7,512.31
|
| Rate for Payer: Humana KY Medicaid |
$3,039.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,070.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,247.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,522.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,651.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,100.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,777.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,628.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,767.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,148.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,739.78
|
| Rate for Payer: PHCS Commercial |
$8,484.49
|
| Rate for Payer: United Healthcare All Payer |
$7,777.45
|
|
|
STEM GMRS LG BOWED PF 13*200MM
|
Facility
|
OP
|
$23,032.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.22 |
| Max. Negotiated Rate |
$22,111.18 |
| Rate for Payer: Aetna Commercial |
$17,735.01
|
| Rate for Payer: Anthem Medicaid |
$7,920.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,965.33
|
| Rate for Payer: Cash Price |
$11,516.24
|
| Rate for Payer: Cigna Commercial |
$19,116.96
|
| Rate for Payer: First Health Commercial |
$21,880.86
|
| Rate for Payer: Humana Commercial |
$19,577.61
|
| Rate for Payer: Humana KY Medicaid |
$7,920.87
|
| Rate for Payer: Kentucky WC Medicaid |
$8,001.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,079.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,268.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,274.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,140.07
|
| Rate for Payer: PHCS Commercial |
$22,111.18
|
| Rate for Payer: United Healthcare All Payer |
$20,268.58
|
|
|
STEM GMRS LG BOWED PF 13*200MM
|
Facility
|
IP
|
$23,032.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.22 |
| Max. Negotiated Rate |
$22,111.18 |
| Rate for Payer: Aetna Commercial |
$17,735.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,965.33
|
| Rate for Payer: Cash Price |
$11,516.24
|
| Rate for Payer: Cigna Commercial |
$19,116.96
|
| Rate for Payer: First Health Commercial |
$21,880.86
|
| Rate for Payer: Humana Commercial |
$19,577.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,268.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,274.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,140.07
|
| Rate for Payer: PHCS Commercial |
$22,111.18
|
| Rate for Payer: United Healthcare All Payer |
$20,268.58
|
|
|
STEM GMRS LG BOWED PF 15*200MM
|
Facility
|
IP
|
$23,032.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.22 |
| Max. Negotiated Rate |
$22,111.18 |
| Rate for Payer: Aetna Commercial |
$17,735.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,965.33
|
| Rate for Payer: Cash Price |
$11,516.24
|
| Rate for Payer: Cigna Commercial |
$19,116.96
|
| Rate for Payer: First Health Commercial |
$21,880.86
|
| Rate for Payer: Humana Commercial |
$19,577.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,268.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,274.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,140.07
|
| Rate for Payer: PHCS Commercial |
$22,111.18
|
| Rate for Payer: United Healthcare All Payer |
$20,268.58
|
|
|
STEM GMRS LG BOWED PF 15*200MM
|
Facility
|
OP
|
$23,032.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.22 |
| Max. Negotiated Rate |
$22,111.18 |
| Rate for Payer: Aetna Commercial |
$17,735.01
|
| Rate for Payer: Anthem Medicaid |
$7,920.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,965.33
|
| Rate for Payer: Cash Price |
$11,516.24
|
| Rate for Payer: Cigna Commercial |
$19,116.96
|
| Rate for Payer: First Health Commercial |
$21,880.86
|
| Rate for Payer: Humana Commercial |
$19,577.61
|
| Rate for Payer: Humana KY Medicaid |
$7,920.87
|
| Rate for Payer: Kentucky WC Medicaid |
$8,001.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,079.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,268.58
|
| Rate for Payer: Ohio Health Group HMO |
$17,274.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,140.07
|
| Rate for Payer: PHCS Commercial |
$22,111.18
|
| Rate for Payer: United Healthcare All Payer |
$20,268.58
|
|
|
STEM GRIT BLAST PS 20X160
|
Facility
|
OP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem Medicaid |
$4,427.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Humana KY Medicaid |
$4,427.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM GRIT BLAST PS 20X160
|
Facility
|
IP
|
$12,873.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,673.50 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: Aetna Commercial |
$9,912.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,040.97
|
| Rate for Payer: Cash Price |
$6,436.52
|
| Rate for Payer: Cigna Commercial |
$10,684.62
|
| Rate for Payer: First Health Commercial |
$12,229.39
|
| Rate for Payer: Humana Commercial |
$10,942.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,555.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,574.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,990.64
|
| Rate for Payer: PHCS Commercial |
$12,358.12
|
| Rate for Payer: United Healthcare All Payer |
$11,328.28
|
|
|
STEM HIP ANG 132^ 25MM*120MM #
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
