|
STEM APEX HUMERAL 9 MINI
|
Facility
|
OP
|
$14,020.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,206.02 |
| Max. Negotiated Rate |
$13,459.26 |
| Rate for Payer: Aetna Commercial |
$10,795.45
|
| Rate for Payer: Anthem Medicaid |
$4,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,935.65
|
| Rate for Payer: Cash Price |
$7,010.03
|
| Rate for Payer: Cigna Commercial |
$11,636.65
|
| Rate for Payer: First Health Commercial |
$13,319.06
|
| Rate for Payer: Humana Commercial |
$11,917.05
|
| Rate for Payer: Humana KY Medicaid |
$4,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,870.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,496.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,346.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,206.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,918.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,337.65
|
| Rate for Payer: Ohio Health Group HMO |
$10,515.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,216.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,197.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,673.84
|
| Rate for Payer: PHCS Commercial |
$13,459.26
|
| Rate for Payer: United Healthcare All Payer |
$12,337.65
|
|
|
STEM APEX HUMERAL 9MM
|
Facility
|
OP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem Medicaid |
$7,103.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Humana KY Medicaid |
$7,103.68
|
| Rate for Payer: Kentucky WC Medicaid |
$7,175.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,246.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
STEM APEX HUMERAL 9MM
|
Facility
|
IP
|
$20,656.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,196.88 |
| Max. Negotiated Rate |
$19,830.00 |
| Rate for Payer: Aetna Commercial |
$15,905.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,111.88
|
| Rate for Payer: Cash Price |
$10,328.12
|
| Rate for Payer: Cigna Commercial |
$17,144.69
|
| Rate for Payer: First Health Commercial |
$19,623.44
|
| Rate for Payer: Humana Commercial |
$17,557.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,938.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,244.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,196.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,177.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,492.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,970.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,252.81
|
| Rate for Payer: PHCS Commercial |
$19,830.00
|
| Rate for Payer: United Healthcare All Payer |
$18,177.50
|
|
|
STEM APEX REVERS HUM SZ 10
|
Facility
|
IP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM APEX REVERS HUM SZ 10
|
Facility
|
OP
|
$14,454.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,336.48 |
| Max. Negotiated Rate |
$13,876.75 |
| Rate for Payer: Aetna Commercial |
$11,130.31
|
| Rate for Payer: Anthem Medicaid |
$4,971.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,274.86
|
| Rate for Payer: Cash Price |
$7,227.48
|
| Rate for Payer: Cigna Commercial |
$11,997.61
|
| Rate for Payer: First Health Commercial |
$13,732.20
|
| Rate for Payer: Humana Commercial |
$12,286.71
|
| Rate for Payer: Humana KY Medicaid |
$4,971.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,021.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,853.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,667.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,070.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,720.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,841.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,563.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,575.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,973.92
|
| Rate for Payer: PHCS Commercial |
$13,876.75
|
| Rate for Payer: United Healthcare All Payer |
$12,720.36
|
|
|
STEM ARCOS 12X115MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X115MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X150MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X150MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X200MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X200MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X250MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 12X250MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X115MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X115MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X150MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X150MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X200MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X200MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X250MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 13X250MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 14X115MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 14X115MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 14X150MM CYL DIST
|
Facility
|
IP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
|
STEM ARCOS 14X150MM CYL DIST
|
Facility
|
OP
|
$23,193.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,958.05 |
| Max. Negotiated Rate |
$22,265.76 |
| Rate for Payer: Aetna Commercial |
$17,858.99
|
| Rate for Payer: Anthem Medicaid |
$7,976.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,090.93
|
| Rate for Payer: Cash Price |
$11,596.75
|
| Rate for Payer: Cigna Commercial |
$19,250.60
|
| Rate for Payer: First Health Commercial |
$22,033.83
|
| Rate for Payer: Humana Commercial |
$19,714.47
|
| Rate for Payer: Humana KY Medicaid |
$7,976.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,057.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,018.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,116.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,958.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,136.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,410.28
|
| Rate for Payer: Ohio Health Group HMO |
$17,395.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,554.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,003.51
|
| Rate for Payer: PHCS Commercial |
$22,265.76
|
| Rate for Payer: United Healthcare All Payer |
$20,410.28
|
|
