|
STEM LPS POROUS 11.5*100MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 12.5*100MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 12.5*100MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 13.5*100MM STR
|
Facility
|
OP
|
$26,899.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,496.88 |
| Max. Negotiated Rate |
$25,823.15 |
| Rate for Payer: Aetna Commercial |
$20,712.31
|
| Rate for Payer: Anthem Medicaid |
$9,250.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,981.31
|
| Rate for Payer: Cash Price |
$13,449.55
|
| Rate for Payer: Cigna Commercial |
$22,326.26
|
| Rate for Payer: First Health Commercial |
$25,554.15
|
| Rate for Payer: Humana Commercial |
$22,864.24
|
| Rate for Payer: Humana KY Medicaid |
$9,250.60
|
| Rate for Payer: Kentucky WC Medicaid |
$9,344.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,057.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,851.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,069.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,436.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,671.22
|
| Rate for Payer: Ohio Health Group HMO |
$20,174.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,379.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,496.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,338.72
|
| Rate for Payer: PHCS Commercial |
$25,823.15
|
| Rate for Payer: United Healthcare All Payer |
$23,671.22
|
|
|
STEM LPS POROUS 13.5*100MM STR
|
Facility
|
IP
|
$26,899.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,496.88 |
| Max. Negotiated Rate |
$25,823.15 |
| Rate for Payer: Aetna Commercial |
$20,712.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,981.31
|
| Rate for Payer: Cash Price |
$13,449.55
|
| Rate for Payer: Cigna Commercial |
$22,326.26
|
| Rate for Payer: First Health Commercial |
$25,554.15
|
| Rate for Payer: Humana Commercial |
$22,864.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,057.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,851.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,069.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,671.22
|
| Rate for Payer: Ohio Health Group HMO |
$20,174.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,379.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,496.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,338.72
|
| Rate for Payer: PHCS Commercial |
$25,823.15
|
| Rate for Payer: United Healthcare All Payer |
$23,671.22
|
|
|
STEM LPS POROUS 13.5*125MM STR
|
Facility
|
OP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem Medicaid |
$8,357.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Humana KY Medicaid |
$8,357.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,442.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,524.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS POROUS 13.5*125MM STR
|
Facility
|
IP
|
$24,301.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,159.14 |
| Max. Negotiated Rate |
$23,329.03 |
| Rate for Payer: Aetna Commercial |
$18,711.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,954.83
|
| Rate for Payer: Cash Price |
$12,150.54
|
| Rate for Payer: Cigna Commercial |
$20,169.89
|
| Rate for Payer: First Health Commercial |
$23,086.02
|
| Rate for Payer: Humana Commercial |
$20,655.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,934.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,290.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,384.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,225.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,860.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,159.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,533.33
|
| Rate for Payer: PHCS Commercial |
$23,329.03
|
| Rate for Payer: United Healthcare All Payer |
$21,384.94
|
|
|
STEM LPS POROUS 14.5*125MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 14.5*125MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 15.5*125MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 15.5*125MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 16.5*125MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 16.5*125MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 17.5*125MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 17.5*125MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 18.5*125MM STR
|
Facility
|
IP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM LPS POROUS 18.5*125MM STR
|
Facility
|
OP
|
$24,079.01
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.27 |
| Max. Negotiated Rate |
$23,115.85 |
| Rate for Payer: Aetna Commercial |
$18,540.84
|
| Rate for Payer: Anthem Medicaid |
$8,280.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,781.63
|
| Rate for Payer: Cash Price |
$12,039.50
|
| Rate for Payer: Cigna Commercial |
$19,985.58
|
| Rate for Payer: First Health Commercial |
$22,875.06
|
| Rate for Payer: Humana Commercial |
$20,467.16
|
| Rate for Payer: Humana KY Medicaid |
$8,280.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,744.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,770.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,223.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,446.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,189.53
|
| Rate for Payer: Ohio Health Group HMO |
$18,059.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,815.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,130.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,464.49
|
| Rate for Payer: PHCS Commercial |
$23,115.85
|
| Rate for Payer: United Healthcare All Payer |
$21,189.53
|
|
|
STEM MODULAR FLUTED 40MM
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
STEM MODULAR FLUTED 40MM
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
STEM MONO SLVD HO SZ12 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ12 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ13 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ13 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ14 240MM
|
Facility
|
OP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem Medicaid |
$12,078.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Humana KY Medicaid |
$12,078.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,201.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,321.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
|
STEM MONO SLVD HO SZ14 240MM
|
Facility
|
IP
|
$35,123.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,566.03 |
| Max. Negotiated Rate |
$33,718.36 |
| Rate for Payer: Aetna Commercial |
$27,044.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,396.17
|
| Rate for Payer: Cash Price |
$17,561.64
|
| Rate for Payer: Cigna Commercial |
$29,152.33
|
| Rate for Payer: First Health Commercial |
$33,367.13
|
| Rate for Payer: Humana Commercial |
$29,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,801.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,920.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,536.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,908.50
|
| Rate for Payer: Ohio Health Group HMO |
$26,342.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,024.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,888.22
|
| Rate for Payer: PHCS Commercial |
$33,718.36
|
| Rate for Payer: United Healthcare All Payer |
$30,908.50
|
|
