|
STEM HIP ANG 132^ 25MM*120MM #
|
Facility
|
OP
|
$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 Medicaid |
$6,834.84
|
| 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: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| 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: Molina Healthcare Medicaid |
$6,971.97
|
| 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
|
|
|
STEM HIP ANG 132^ 30MM*130MM #
|
Facility
|
OP
|
$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 Medicaid |
$6,834.84
|
| 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: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| 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: Molina Healthcare Medicaid |
$6,971.97
|
| 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
|
|
|
STEM HIP ANG 132^ 30MM*130MM #
|
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
|
|
|
STEM HIP ANG 132^ 30MM*140MM #
|
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
|
|
|
STEM HIP ANG 132^ 30MM*140MM #
|
Facility
|
OP
|
$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 Medicaid |
$6,834.84
|
| 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: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| 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: Molina Healthcare Medicaid |
$6,971.97
|
| 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
|
|
|
STEM HIP ANG 132^ 40MM*170MM
|
Facility
|
OP
|
$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 Medicaid |
$6,834.84
|
| 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: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| 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: Molina Healthcare Medicaid |
$6,971.97
|
| 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
|
|
|
STEM HIP ANG 132^ 40MM*170MM
|
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
|
|
|
STEM HIPANG 132^40MM*170MM #12
|
Facility
|
OP
|
$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 Medicaid |
$6,834.84
|
| 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: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| 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: Molina Healthcare Medicaid |
$6,971.97
|
| 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
|
|
|
STEM HIPANG 132^40MM*170MM #12
|
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
|
|
|
STEM HIP OFFSET 3 32.5*101MM
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM HIP OFFSET 3 32.5*101MM
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM HIP OFFSET 8 38*111MM
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM HIP OFFSET 8 38*111MM
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
STEM HUMERAL 10*148MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 10*148MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 11*151MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 11*151MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 12*151MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 12*151MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 13*151MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 13*151MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 14*151MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 14*151MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 15*151MM
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
STEM HUMERAL 15*151MM
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
